Paris - September 1 7 -2 0, 2007 www.iois-paris-2007.com
Abstract Book IUSG International Ocular Inflammation Society
International Uveitis Study Group
with the participation of:
AMERICAN UVEITIS SOCIETY
SPEIO Society for Ocular Immuno-Infectiology in Europe
Sociedad Panamericana de Enfermedades Inflamatorias Oculares
The Hellenic Society for the Study of Ocular Inflammations and Infections (HSSOII) The Uvea-Behcet Division of the Turkish Ophthalmological Society (UBDTOS) The Chinese Ocular Immunology Association (COIA) The Brazilian Uveitis Society
FOSTER OCULAR IMMUNOLOGY SOCIETY
IOIS - Paris - September 17-20, 2007
Abstract Book
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Co n fe re n ce we bs i te : http://www.iois-paris-2007.com DISCLAIMER As specified in the Submission Guidelines, the abstracts selected by the Scientific Committee of the 9th IOIS Congress for poster or oral presentations, have been reproduced in the form they were submitted, and have not been re-typed or corrected. The publisher cannot be held responsible for any errors in spelling or grammar that appear in these texts. 1
Abstract Book ORGANIZERS : Phuc LEHOANG, David BENEZRA, Bahram BODAGHI LOCAL SCIENTIFIC COMMITTEE Christophe Baudouin Francine Behar-Cohen Vincent Borderie Tristan Bourcier Alain Bron
Isabelle Cochereau Catherine Creuzot-Garcher Serge Doan Laurent Kodjikian Yvonne de Kozak
Pierre Labalette Marc Labetoulle Pierre-Yves Robert Michel Weber
Guest members: Ahmed M. Abu El-Asra (Saudi Arabia), Moncef Khairallah (Tunisia), Carl Herbort (Switzerland) IOIS EXECUTIVE BOARD President: Phuc LeHoang (Paris, France) Chair: Leyla S. Atmaca (Ankara, Turkey) General Secretary and Treasurer: Jorge L. Alió (Alicante, Spain) Council representative: Martin Filipec (Prague, Czech Republic) International Council Coordinator: Antonio G. Secchi (Padova, Italy) Past Presidents: David BenEzra (Jerusalem, Israel), Shigeaki Ohno (Yokohama, Japan)
IOIS EXECUTIVE INTERNATIONAL COUNCIL Argentina: F. Scattini Australia: J. Smith, P. Mc Cluskey Austria: T. Von Barisani Belgium: L. Caspers - Velu Brazil: S. Hayashi, C. Mucciolli Canada: E. Fortin, F. Roberge Colombia: B. J. Bajaire, A. de la Torre Croatia: K. Karaman Cyprus: A. Lapithis Czech Republic: M. Filipec Denmark: H. Fledelius Dominican Republic: C. D. Heredia Egypt: M. Hamdi and S. Zohni Finland: R. Uusitalo France: C. Baudouin, F. Behar-Cohen, Y. de Kozak
Germany: M. Becker, U. Pleyer, S. Thurau , M. Zierhut, G. Wildner Greece: N. Markomichelakis Holland: M. De Smet Hungary: P.Orosi India: J. Biswas, A. Gupta, P. Nagpal Indonesia: F. Asyari, G. Simanjuntak Israel: D. Briscoe Italy: M. Accorinti, S. Bonini, A. Leonardi Japan: M. Mochizuki, M. Usui, K. Yamaki, N. Mizuki Lithuania: A. Kalasauskiene Mexico: L. Arellanes, G. Ortega-Larrocea Philippines: Harvey S. Uy Portugal: J. Palmares Puerto Rico: J. A. Flores, R. Proença
Russia: E. Drozdova Saudi Arabia: A. Abu El Asrar, K. Tabbara Slovak Republic: T. Juhas Slovenia: A. Kraut South Africa: E. Dahan Spain: B. Carreras, M. Maldonado Sweden: L. Tallstedt Switzerland: C. P. Herbort Tunisia: A. Ladjini, M Khairallah Turkey: B. Eldem, M. Karaçorlu, Y. Ozyazgan, I. Tugal Tutkun U.K: V. Calder, H. Singh Dua USA: J. Davis, S. Foster, I. Gery, G. Holland, H. Kaplan, J. Pepose, N. Rao Venezuela: F. J. Arévalo
IOIS SECTIONS CHAIRPERSONS - Basic Sciences: I. Gery, G. Wildner, V. Calder and Y. de Kozak - Epidemiology: M. Mizukki and J. Biswas - Diagnostic Procedures: B. Bodaghi and M. Mochizuki - Imaging in Ocular Inframmation: C. Herbort, Atmaca and I. Tugal-Tutkun - Scoring Systems: S. Ohno and S. Baarsma. - Clinical Trials: M. D. De Smet and L. Caspers - Ocular Pathology: N. Rao and Chao Chan - Immune Pharmacology and Drug Delivery Systems: F. Behar-Cohen, J.L Bourges and D. BenEzra - Neuro-ophthtalmology: T. Barisani-Asenbauer and N. Cassoux - Allergy: A. Leonardi and B. Carreras - Ocular Surface: C. Baudouin and H. Singh Dua - Transplantation Immunology: U. Pleyer and M. Filipec. - Anterior Segment Intraocular Inflammation: P. Mc Cluskey and A. Okada - Anterior Segment; Cataract and Refractive Surgery: J. L. Alió, K. Tabbara and M. J. Maldonado - Posterior Segment Inflammation and Surgery: J. Davis, M. Becker and J. Montero - Macula: C. D. Heredia and K. Yamaki - Pediatric Ophthalmology and Inflammation: D. BenEzra and B. Bodaghi - Ocular Neovascularization: J. M. Ruiz-Moreno and L. Arellanes-García - Orbital Inflammation and Oculoplastics: D. Briscoe - Systemic Diseases: A. Secchi and L. Atmaca 9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 2
Summary The 9th IOIS Congress Abstract Book is divided into five chapters. Chapter 1 – Plenary Sessions This chapter contains the abstract presentations for the Plenary Sessions: P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P14 P15 P16 P17 P18 P19 P20 P21 P22 P23 P24-P25 P27
Pediatric Ophthalmology and Inflammation Anterior Segment Intraocular Inflammation Anterior Segment, Cataract and Refractive Surgery Behçet Basic Sciences AUS Session Ocular Pathology ARMD Allergy Endophthalmitis Combined SOIE-IOIS Imaging Session Non-uveitic Ocular Inflammations Ocular Surface Transplantation Immunology SPEIO and Brazilian Uveitis Society Session IUSG Session – Scleritis Immune Pharmacology and Drug Delivery Systems Neuro-ophthalmology Orbital Inflammation and Oculoplastics Surgery Diagnostic Procedures Systemic Diseases Ocular Neovascularization Posterior Segment Inflammation and Surgery: Clinical Trials Section & Classification and Scoring Section Macula
Please refer to the Congress Program for the scheduled times and meeting rooms for these sessions. Chapter 2 – Satellite Symposia This chapter contains the abstract presentations submitted for the eight Satellite Symposia which will be held during the Congress: S1 - THEA Symposium: “Which Place for Corticotherapy in 2007?” S2 - LUX BIOSCIENCES Symposium: “Steroid-sparing Approaches in Immunomodulation.” S3 - NOVAGALI PHARMA Symposium: “Allergy of the Ocular Surface.” S4 - ALCON Symposium: “Latest Approaches in Inflammation Treatment” S5 - LFB Symposium: “Effects of IVIg in Uveitis: From Pathophysiology to Clinical Applications.” S6 - BAUSH & LOMB Symposium: “Ocular inflammation: Clinical Approach and Latest Therapeutic Advances” S7- ALLERGAN Symposium: “Uveitis Cystoid Macula Edema” S8 - ALLERGAN Symposium “Dry Eye Pathogenesis and Treatment” Please refer to the Congress Program for the scheduled times and meeting rooms for these sessions. 9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 3
Summary Chapter 3 – Oral presentations This chapter includes the free papers submitted to the IOIS Congress Scientific Committee that have been accepted for oral presentations (7 minutes). Eleven oral presentation sessions are scheduled during the Congress: OP1 Basic Sciences OP2 Pediatric, ASII & AS Cataract OP3 Behçet OP4 ARMD / Ocular Neovascularization / Macula OP5 Allergy / Ocular Surface / Transplantation OP6 Imaging OP7 Diagnostic Procedures OP8 PSIS / VKH OP9 Neuro / Orbital inflammation / Systemic Diseases OP10 Drug Delivery / Clinical Trials / Classification & Scoring OP11 Endophthalmitis / Epidemiology Please refer to the Congress Program for the scheduled times and meeting rooms for these sessions. Chapter 4 – “Rapid Fire” Presentations This chapter includes the free papers submitted to the IOIS Congress Scientific Committee that have been accepted for short “Rapid Fire” presentations (3 minutes). Two “Rapid Fire” sessions are scheduled during the Congress: RF1 Pediatric / ASII / Allergy / Endophthalmitis / Imaging / Ocular Surface / Drug Delivery / VKH / Herpes RF2 Orbital inflammation / Diagnostic Procedures / Systemic Diseases / Neovascularization / PSIS / Trials / Classification / Epidemiology / Macula Please refer to the Congress Program for the scheduled times and meeting rooms for these sessions. Chapter 5 – Posters This chapter includes the free papers submitted to the IOIS Congress Scientific Committee that have been accepted as posters. Posters are displayed for one day, during the first three days of the Congress. POSTER PO2-23 Posterior Segment Poster Display - Tuesday, September 17 POSTER PO2-27 Macula POSTER PO1-1 Pediatric POSTER PO2-30 Herpes POSTER PO1-2 ASII POSTER PO1-3 AS Cataract Poster Display, Wednesday, September 19 POSTER PO1-4 Behçet POSTER PO3-16 Scleritis POSTER PO1-5 Basic Sciences POSTER PO3-17 Drug Delivery POSTER PO1-22 Ocular Neovascularisation POSTER PO3-18 Neuro-ophthalmology POSTER PO3-19 Orbital inflammation Poster Display – Tuesday, September 18 POSTER PO3-20 Diagnostic Procedures POSTER PO2-8 ARMD POSTER PO3-21 Systemic Diseases POSTER PO2-9 Allergy POSTER PO3-24 Clinical Trials POSTER PO2-10 Endophthalmitis POSTER PO3-26 Epidemiology POSTER PO2-11 Imaging POSTER PO3-28 VKH POSTER PO2-12 Non-uveitic Ocular Inflam. POSTER PO3-16 Investigation POSTER PO2-13 Ocular Surface POSTER PO2-15 Intra-Ocular and Juxta Scleral Injections and Implants A general index of authors is included at the end of the 9th IOIS International Congress Abstract Book. 9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 4
Abstract Book P1-1 AUTOINFLAMMATORY CONDITIONS IN CHILDREN: WHAT SHOULD WE KNOW? Anne-Marie Prieur (Paris, France) M a i n ly four groups of diseases are at risk of eye inflammation with various degrees of severity. 1) Ju venile Idiopathic Arthritis (JIA). Th e most common is ch ronic anterior uveitis in the oligoarticular fo rm o c c u rring mostly in very young gi rls and associated with serum antinuclear antibody. Acute anterior uveitis can be observed is young boys with enthesitis associated arthropathy. 2) Some autoimmune conditions are ch a ra c t e ri zed by eye inflammation. Wegener granulomatosis ch a ra c t e ri zed by ANCA affects small and medium sized vessels with sinusitis, upper re s p i ratory and pulmonary tract, kidney… Eye manife s t ations are from mild conjunctivitis to severe inflammation (kerat itis, retinal vasculitis). Cogan syndrome consists of a vestibuloauditory syndrome with sudden hearing loss and bilat e ral interstitial kerat itis. Sjögren syndro m e, associated to anti Ro anti La antibodies, is ch a ra c t e ri zed by dry eye with salivary glands swelling and dry mouth, sometimes kidney involvement 3) Genetic disord e rs. The diseases associated to mu t ations of the CIAS1, particularly CINCA, MWS are associated with optic disk ch a n ges, (oedema, at ro p hy) ch ronic anterior uveitis and often visual loss. Mevalonate kinase deficiency due to mu t ation in the MVK gene , also called hyperIgD syndrome is assoc i ated to cat a racts in its most severe type affecting the infant. Eye involvement in Blau syndrome, due to a mu t ation of the CARD15 gene (also called familial sarcoidosis) is part of the triad characterizing the disease with skin rash and art h ritis. Eye involvement in Behçet disease can affect anterior and/or posterior segment, or manifests as iridocyclitis, hypopion or retinal vasculitis, optic disk hyperemia and macular oedema. 4) Other diseases such as tubu l o i n t e rstitial nep h ritis and uveitis (TINU) or Vogt Koyanagi Harada syndrome are also assoc i ated with eye manifestations.
P1-2 EPIDEMIOLOGY OF CHILDHOOD UVEITIS: RESULTS OF AN INTERNATIONAL RETROSPECTIVE MULTICENTER ANALYSIS OF UVEITIS PATIENTS < 19 YEARS Friederike Mackensen1, Sandra Prazeres2, Matthias D. Becker1, Marie-Sophie Enzmann1, Celine Terrada2, Bahram Bodaghi2, A n gela Watkins3, G e o rge Reed4, Julie Friedlin5, Dimitry Pyatesky5, H. Nida Sen4, Debra Goldstein5, Justine R. Smith3, Janine A. Smith4 1 Interd i s c i p l i n a ry Uveitis Center, U n ive rsity of Heidelberg, Germany, 2 Hopital Pitie-Salpetriere, Paris, France, 3 Casey Eye Institute, OHSU, Portland, OR, USA, 4 National Eye Institute, Bethesda, MD, USA, 5University of Illinois, Chicago, IL, USA Purpose: To describe etiologies, disease activity, and prognosis of pediatric uveitis. Methods: Databases review from 5 uveitis centers (3 US and 2 EU) with standardized definitions and time points. Results: 853 (527 US, 326 EU) patients with follow-up of 1-10 yrs were identified. Median age at presentation was 11.2 (US) and 11.0 years (EU), median age at first diagnosis 9.1 (US) and 9 years (EU). Both groups showed a similar gender distribution (F:M 1.2:1). Centers differed significantly in percentage of Caucasian patients (EU 88%, US 51-78%).
The most frequent diagnosis in the US was idiopathic uveitis (28.8%) followed by juvenile idiopathic arthritis (JIA) -related uveitis (20.9%); in contrast JIA was the most frequent diagnosis in EU centers (30.8%). In all centers JIA was more frequent among the children with longer follow-up. Uveitis was active as judged by SUN cri t e ria in 75/79% of ch i l d re n at the fi rst visit and in 55/40% at the 5 year visit (US/EU). Legal blindness (VA < 20/200 in the better eye) was diagnosed in 3/4% at the fi rst visit and 9/10% at the 5 year and 8/12.5% at the 10 year visit. Th e re was a negative correlation between VA > 20/50 and complications at first visit, especially CME and hypotony (p = 0.006 and 0.026) in the US group and epiretinal membrane (p = 0.0425), band keratopathy, CME and cataract (p = 0.05) in the EU cohort. At first visit a mean number of 1.4/1.7 (US/EU) complications were present per child: the most frequent complications were cataract (28/22%), CME (16.6/11.6 %) and glaucoma (6.4/0.6 %). In the group of children followed for at least 5 years, 56/46% had cataract, 30.4/15.38% had CME, and 18.8/25% had glaucoma at some time during this period. 95/91% received systemic immunosuppressive therapy at any time, which involved combination therapy of prednisone (or equivalent) and systemic immunosuppressive drugs (including biologics) in 37/37%. Use of systemic immu n o s u p p ressive drugs such as methotrexate alone or in combination was more frequent in the EU (52%) than in the US (27 %). The use of biologics was also slightly more frequent in the EU (10%) than in the US (6%). More children in EU (29%) than in the US (17%) had surgery during the observed period. Cataract extraction was the most frequent type of surgery. Conclusion: Children with uveitis followed by specialized centers over a long period of time have active and severe disease which re q u i res intensive treatment, fre q u e n t ly involving systemic immunosuppressive drugs including biologics. Still only 10 -12.5% of them showed legal blindness at the 5-10 year time point, a number smaller than observed historically, that will hopefully further decline with the increasing availability of a range of systemic immunosuppressive drugs.
P1-3 CLINICAL CHARACTERISTICS OF UVEITIS IN CHILDREN Arellanes Lourdes (Asociacion Para Evitar la Ceguera en México) A review of the unique challenges that children with uveitis represents will be made. Practical difficulties involved in getting an accurate history and a complete eye examination will be analyzed. Differences in clinical manifestations, uveitis syndromes and differential diagnosis will be shown. Medical therapy may also be more difficult because children with uveitis have unique dosing requirements, drugs - associated risks and compliance issues. In children a delayed uveitis diagnosis is frequently made, which can be associated with development of complications such as cataract, glaucoma, cyclitic membrane formation, band keratopathy, etc. Great care must be taken when choosing the best surgical technique in each case. Financial fundings:None Conflict of interest: None Keywords: Different manifestations, compliance problems, different diagnosis
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 5
Abstract Book P1-4 P ROGNOSIS OF JUVENILE IDIOPATHIC ARTHRITIS ASSOCIATED UVEITIS Kaisu Kotaniemi (Finland) Anterior uveitis is a feature of 20% of patients with juvenile idiopathic arthritis (JIA). Being mostly asymptomatic, chronic and bilateral, it is a potentially blinding disease and the management is a great challenge. Two decades ago it was assessed that 25% of JIA patients with uveitis do well, 50% have a moderate prognosis with proper treatment, and 25% have a poor prognosis despite best possible treatment ( Kanski 1990). A long-term follow up study from Denmark revealed an eye manifestation in 20% of 65 JIA patients. After mean 27 years of follow up time, 33% of them had active uveitis. All of them had complications, but everyone had good (?0.6) binocular visual acuity (Zak et al 2003). Packham and colleagues (2002) published a series of 246 adult JIA patients, mean age 35 years, after the mean 28 years follow up. Uveitis had occurred in 22% and 10% had cataract, 4% glaucoma and 15% sicca syndrome. In an American series of 89 JIA patients, 76 had uveitis (165 eyes). After 3 years of follow up the visual acuity was good (?0.5) in 73% and poor in 18% of eyes. One or more complications occurred in 64% of patients (Kump et al 2006). In a Finnish study of 104 JIA patients with associated uveitis, 54 patients had still active uveitis after the mean follow up time of 9.7 years. In altogether 86 eyes, the visual acuity was good (? 0.5) in 83% and poor (<0.1) in 4% of eyes (Kotaniemi and Sihto-Kauppi 2005, unpublished). In another Finnish group of 123 young adults with JIA examined at the mean age of 23 years, uveitis was found in 20% of patients. Uveitis was still active in 32% of uveitis patients after the mean follow up of 15 years. Binocular visual acuity was good (?0.8) in all, in 3 eyes <0.1. Complications were common: cataract 20%, glaucoma 16%, CME 4% and a blind eye in 8%. A very recent report from Italy consisted of 309 JIA patients of whom 20.1% developed uveitis. After the mean follow up of 7.6 years complications of uveitis were found in 35% of the patients leading to blindness in 13 (21%) patients (Grassi et al 2007). Prognosis of JIA-associated uveitis is better than a couple of decades ago. Careful monitoring of JIA patients and effective treatment of uveitis with immunomodulators and new biologic drugs in close cooperation with pediatric rheumatologists is highly important in saving the sight of these patients.
P1-5 THE MEDICAL TREATMENT OF CHILDREN WITH UVEITIS Foster C. Stephen Introduction and Objectives: Children comprise approximately 10% of the uveitis universe, yet they account for a disproportionate percentage of the population of patients blinded by uveitis. This invited presentation illustrates the Massachusetts Eye Research and Surgery Institute (MERSI) philosophy in caring for children with uveitis, and the model of medical care we employ. Methods: Systematic presentation of the MERSI model of medical therapy, with illustrative case examples. Results: Juvenile idiopathic arthritis associated uveitis represents,
by far, the most common systemic entity associated with pediatric uveitis. It is typically chronic and ocularly pernicious when not treated sufficiently vigorously. Corticosteroids, through all available routes, is always the first therapy employed. However, chronic corticosteroid therapy is clearly inappropriate, and steroid-sparing therapy, beginning with oral non-steroidal anti-inflammatory agents (NSAIDs), is the second step on the MERSI stepladder paradigm, followed by immunomodulatory therapy for those patients who continue to require corticosteroids despite oral NSAID therapy. Methotrex ate, my c o p h e n o l ate mofetil, azat h i o p ri n e, cyclosporin and even chlorambucil are the agents which we have found most useful in the quest for induction of steroid-free durable remission of the uveitis. Biologic response modifiers (BRMs)also play an increasingly important role in the MERSI model of care of children, with daclizumab, infliximab and adalimumab the current primary BRMs employed. The success rate of this approach to therapy of children with all forms of non-infectious chronic or recurrent uveitis is striking, with eventual drug-free durable remission achievable in over 70% of instances. Conclusions: Steroid monotherapy for chronic uveitis in both adults and in children no longer represents the standard of care. A stepladder algorithm of steroid sparing anti-inflammatory therapy can salvage the vision of children who otherwise would be blind from uveitis or from the consequences of chronic steroid therapy. Financial fundings: None Conflict of interest: None Keywords: Uveitis, Treatment, Children
P1-6 SURGICAL MANAGEMENT OF PEDIATRIC IOI COMPLICATIONS David BenEzra (BenEzra Eye Institute, Assuta Medical Center, Rishon, Israel) Intraocular inflammation (IOI) may induce complications needing surgical intervention. They can result from an infectious or a noninfectious IOI. The ocular complications may encompass all eye structures and are always tightly associated with the following major factors: 1- The type of IOI: anterior, intermediate, posterior or a combination of these. 2- The duration of manifestations: acute, chronic-latent or chronicactive. 3- The strategy of medical treatment: use of a single anti-inflammatory drug or a combination of drugs (on initial management or only at a later stage). 4- The philosophy of medical treatment: "fight" the presence of every single cell and mild flare in the anterior chamber (or vitreous) or treat only in the presence of active inflammation. 5- The route of drug(s) administration: local external, regional, intraocular or systemic 6- Accuracy of diagnosis of the so called auto-immune or "idiopathic" manifestations. 7- Association of the IOI with systemic disease. 8- The child's age at the time of diagnosis and more importantly, the age at time of surgical attempt. When medical treatment is well balanced and effective, the ocular complications needing surgical intervention are minimized and can
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 6
Abstract Book be completely avoided. However, in some cases, despite the appropriate medical management (at times, induced by it), complications affecting visual function develop. These are more prone to occur in younger than older children. Corneal complications, severe vitreous organization or retinal detachment needing surgical intervention are observed sporadically. Glaucoma (acute, chronic angle closure and OAG) and cataract severely affecting the child's visually abilities and needing surgical intervention are more commonly observe d. Th e s e, there fo re deserve special considerations. In this presentation, I will describe briefly the techniques of glaucoma surgery I have performed during the years and will delve more deeply into a new surgical technique for cataract surgery in these children.
P2-1 TOLL RECEPTORS AND ANTERIOR UVEITIS Denis Wakefield UNSW, Sydney. Australia Toll-like receptors (TLRs) are a family of pattern-recognition receptors of the innate immune system that recognize unique pathogen associated molecular patterns (PAMPs). There are 11 TLRs identified in man and these have several important functions and have been recently implicated in the pathogenesis of various inflammatory eye diseases including uveitis. In addition to ligand specificity, individual TLRs differ in their expression patterns and the signal transduction pathways they activate. All TLRs sense microbial components and trigger a multitude of antimicrobial and infl a m m at o ry responses. TLR activation tri gge rs the earl i e s t immune mechanisms involved in activating and recruiting leukocytes to the site of inflammation by inducing the expression of adhesion molecules, chemokines, p ro - i n fl a m m at o ry cytokines, matrix metalloproteinases (MMPs), and activating the effector functions of innate immune cells, such as the phagocytic function of neutrophils. Furthermore, by activating the maturation of antigen presenting cells (APCs), such as dendritic cells, TLRs have been shown to be important in activating and modulating the adaptive immune response. We initially demonstrated the expression of TLR4 and its associated lipopolysaccharide (LPS) receptor complex by resident APCs in the normal human uvea. LPS receptorbearing APCs appeared to be strategically placed in perivascular and subepithelial locations in the uveal stroma, possibly to survey blood-borne or intraocular LPS. Given the role of GNB in triggering immune-mediated uveitis, we postulated a novel mechanism by which the LPS of GNB may initiate ocular inflammation by activating TLR4 expressed on uveal APCs. Supporting this hypothesis is the fact that mouse strains that have a naturally defective TLR4 gene (C3H/HeJ) do not develop endotoxin-induced uveitis (EIU). We have demonstrated differences in the level of expression of TLR2 in patients with acute anterior uveitis (AAU) compared to healthy control subjects. Several of the existing animal models of AAU are dependent upon microbial triggers to induce ocular inflammation, either in the form of bacterial components (LPS, LTA/lipoteichoic acid), PGN/peptidoglycan), and muramyl dipeptide) or whole live bacteria. EIU is a particularly useful model for AAU given the aetiological association of AAU with GNB triggers. Products of GNB (eg. LTA, PGN) have also been shown to induce uveitis. TLRs may provide the critical pathogenic link between the experimental and clinical observations of microbial triggers to the development of non-infectious, immune-mediated uveitis. Our recent studies have demonstrated selective perturbations in TLR
function and expression in patients with AAU. We have also recently shown that multiple LPS-inducible cytokines are elevated in the AqH of patients with active AAU. TLRs may also be activated by endogenous damage associated molecular proteins (DAMPs) that may trigger or reactivate uveitis. This is the basis of the so called Toll hypothesis of uveitis.
P2-2 HLA B27-ASSOCIATED ANTERIOR UVEITIS Rosenbaum James T., Rosenzweig Holly, Smith R. Justine, Planck R. Stephen, Davey P. Michael, Martin R. Tammy Oregon Health & Science University (OHSU) HLA B27, a type I Major Histocompatibility Complex antigen, predisposes to spondyloarthritis such as ankylosing spondylitis or reactive arthritis and acute anterior uveitis, associations that have been recognized for more than 30 years. HLA B27-associated uveitis is the most common type of uveitis diagnosed in North America and Europe. HLA B27-associated uveitis has a consistent phenotype: sudden onset; unilateral with recurrences that may occur in the contralateral eye; and anterior. Pressure in the affected eye is typically lower than the contralateral eye. Hypopyon, anterior chamber fibrin, and posterior synechiae are commonly observed. HLA B27 is also associated with the uveitis that can complicate either psoriatic arthritis or inflammatory bowel disease (IBD), but these associations are less consistent than the association between B27 and anterior uveitis in the setting of ankylosing spondylitis. In addition, the clinical characteristics of uveitis associated with either psoriatic arthritis or IBD are more varied than those characteristic of the uveitis associated with ankylosing spondylitis. Despite the strength of the association, the mechanism by which B27 predisposes to either arthritis or uveitis is still unproven. Several animal models demonstrate aspects of spondyloarthritis. We have recently observed uveitis in association with an animal model of sacroiliitis. The elucidation of additional genetic factors that undoubtedly contribute to the pathogenesis of B27-related eye disease and analysis of gene expression during active uveitis will also clarify the pathogenesis of HLA B27-associated anterior uveitis. Financial fundings: National Eye Institute, Stan and Madelle Rosenfeld Family Trust, Research to Prevent Blindness Conflict of interest: None Keywords: HLA B27, ankylosing spondylitis, anterior uveitis
P2-4 VIRAL INTRAOCULAR SEGMENT INFLAMMATION Caspers Laure E (CHU St Pierre) Anterior segment viral eye diseases are common but are more frequently located to the cornea than intraocular. Most of these viruses are from the herpes family with the typical aspect of sectorial iris atrophy. It can occur isolated or associated with a systemic viral infection. For example VZV anterior segment can occur with the cutaneous infection of sine herpete. Experimental models and clinical observations tend to show that inflammation of the anterior segment can result from the direct viral infection of result from and immune mediated inflammation induced previously by a viral infection. Molecular techniques, in particular polymerase chain reaction (PCR) have been useful to characterize different virus inducing anterior segment IOI. PCR detection of the viral genome
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 7
Abstract Book is a rapid, sensitive an accurate technique and can be used as soon as the viral infection is suspected, while Golmann-Witmer coefficient can be been useful to detect viral infections after a couple of weeks and can also detect older infections, even when the viral genome is not present anymore in the anterior segment. PCR can be useful to detect a viral origin to uveitis unresponsive to anti-inflammatory agents. New viral anterior segment IOI have been identified such as cytomegalovirus-associated chronic anterior uveitis (I de Schrijver, British Journal of Ophthalmology 2006;90:852-855) and rubeola infection in Fuch's heterochromic iridocycitis (De GrootMijnes Am J Ophthalmol. 2006 Jan;141(1):212-214. Antiviral drugs should be promptly used to control viral replication before the use of corticosteroids and antiviral drug should be maintained until the end of the corticosteroid treatment. Maintenance therapy based on low-dose of antivirals could be considered to reduce the rate of recurrence and should be considered in some viral entities. Financial fundings: (None.) C o n flict of intere s t : (None.) Key wo rd s : virus, i n t raocular anterior segment, PCR
P3-5 CATARACT SURGERY IN UVEITIS PATIENTS: INFLAMMATION CONTROL AND SURGICAL TECHNIQUES Rutzen Allan R. (University of Maryland School of Medicine) Patients with uveitis often develop cat a ra c t s , either as a result of intraocular inflammation or the long-term use of topical or systemic corticosteroids. Cat a ract surge ry in patients with uveitis can be particularly ch a l l e n ging when patients have re c a l c i t rant inflammation, posterior synechiae, peripheral anterior synech i a e, small pupils, elevated intraocular pre s s u re, and pre existing macular edema. Successful surge ry depends on excellent pre o p e rative control of inflammation, special surgical tech n i q u e s , and aggressive postoperative management of infl a m m ation and macular edema. This lecture will discuss current recommendations for inflammation control and p ractical surgical techniques for cat a ract surge ry in patients with uveitis. Financial fundings: none C o n flict of interest: none Key wo rds: cataract, surge ry, uveitis
P3-1 DIFFERENTIAL DIAGNOSIS OF THE INFLAMMATORY RESPONSES OF THE CORNEA IN MODERN REFRACTIVE SURGERY Maldonado Miguel J. (Clinica Universitaria de Navarra) Introduction and objectives: As refractive surgery has evolved over the last few decades, new inflammatory and pseudo-inflammatory conditions have been known to appear as a consequence of these particular corneal procedures beyond infectious keratitis. The goal of this presentation is to describe the most relevant ones. Methods: Case series Results: Following LASIK, diffuse lamellar keratitis can present as an epidemic or sporadic complication and can exhibit an early or a late onset, the latter mainly related to a post-traumatic or non-specific origin. Other aetiologies can mimic an inflammatory corneal response; intraocular pressure elevation in the presence of a corneal flap or other mechanical causes can lead to a “pseudo-inflammatory diffuse lamellar keratitis”. The adequate diagnosis of the latter is of paramount importance because inappropriate management can lead to further increase in intraocular pressure and, eventually, to i rreve rs i ble visual loss. Other infl a m m at o ry complications of LASIK include central flap necrosis, which may appear after microkeratome or femtosecond laser flap creation, and nummular keratitis, among others. The initial use of the femtosecond laser, particularly at 15 kHz, associated a transient light-sensitivity syndrome that was related to post-LASIK interface inflammation. Advanced surface ablation procedures, unlike LASIK, can present inflammatory complications associated to a delayed epithelial healing and/or the use of bandage contact lenses. Finally, dry eye, a most prevalent condition after all kind of laser refractive corneal procedures has an infl a m m at o ry component that should be acknowledged and addressed appropriately. Conclusions: Awareness of the above-mentioned syndromes is warranted for the adequate management of the corneal refractive patient presenting with a presumed inflammatory complication. Financial fundings: None C o n flict of intere s t : None
Key wo rds: inflammation, LASIK, PRK
P4-2 OCULAR INVOLVEMENT AND VISUAL PROGNOSIS Tugal-Tutkun Ilknur ( I s t a n bul Unive rsity Istanbul Faculty of Medicine Dept of Ophthalmology) Patients with Behçet’s disease typically have a bilateral panuveitis and retinal vasculitis. The course of the disease is characterized by recurrent uveitis attacks and spontaneous remissions. Anterior segment inflammation is always nongranulomatous. Fibrinous reaction is uncommon. The hypopyon in Behçet’s patients shows a smooth layer and shifts freely with head positioning. Vitritis is a constant feature of posterior segment involvement. Although all types and sizes of retinal vessels may be inflamed, periphlebitis is the predominant feature. Occlusive vasculitis may cause profound retinal ischemia. Retinal infiltrates or necrotizing retinitis may be seen during activations. Macular edema is the most common complication. End-stage fundus picture is characterized by optic atrophy, empty vessels, and diffuse retinal atrophy and gliosis. Male patients have a more severe disease from the onset and a worse visual prognosis than females. Financial fundings: (None.) Conflict of interest: None Keywords: Behcet's disease, uveitis, visual prognosis
P4-4 PEDIATRIC BEHCET'S DISEASE Khairallah Moncef (University Hospital, Monastir, Tunisia ) Behçet’s disease (BD) is frequently encountered in Far East, Middle East and countries around the Mediterranean area. It is mainly observed in young adults, but rarely in children. The systemic findings of BD in children are similar as in adults, but the frequency of familial cases is significantly higher. The rate of ocular involvement ranges from 27% to 80% in the published series
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 8
Abstract Book of pediatric BD. BD accounts for 6% to 13 % of pediatric patients with uveitis in countries where the disease is common (when compared with only 0% to 0.7% in Europe and North America). Pediatric BD uveitis commonly occurs in late childhood, with males more frequently affected than females. The clinical features are similar to that seen in adults, with bilateral panuveitis,frequently associated with retinal vasculitis and retinitis, seen in the majority of patients. The most common complications include cataract, maculopathy, and optic atrophy. The treatment of pediatric BD uveitis is challenging, as the use of systemic corticosteroids is associated with significant complications and response to conventional immunosuppressive therapy variable. The visual prognosis of patients with pediatric BD uveitis may be relatively good or poor. It can be improved with early diagnosis, prompt and appropriate immunosuppressive therapy, and the use of biologic agents. Financial fundings: (None.) Conflict of interest:(None.) Keywords: Behçet, uveitis, pediatric
P4-7 ANTI-TNF ALPHA THERAPY IN BEHCET'S DISEASE Shigeaki OHNO Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan Prognosis of ocular lesions in Behcet’s disease, particularly that of uveoretinitis has been poor. The main reason for this is that uveoretinitis is chronic and recurrent even with systemic colchicine and/or ciclosporin. New treatment modalities have long been expected. Recently, our group found that the production of TNF-alpha is sign i fi c a n t ly enhanced in patients with active ocular lesions. Therefore, we thought that suppression of TNF-Alpha by infliximab may be beneficial for this disease. We conducted clinical trials either with 5mg/kg or 10mg/kg of intravenous infliximab. As a result, both groups showed significant clinical effects on the ocular lesions, and this treatment seems quite promising. In this paper, details of infliximab treatment in Behcet’s disease will be presented.
P5-1 INTRODUCTION AND OVERVIEW Calder Virginia L (UCL Institute of Ophthalmology) Introduction: The interplay between lymphocytes and their soluble mediators (cytokines and chemokines) is highly complex. In uveitis, CD4+T cells have been demonstrated to play an important role at different stages of the inflammatory cascade. However, other immune cells, as well as tissue-resident cells, are also critical. Studies have recently assayed multiple analytes in small sample volumes of aqueous humor (AH) specimens from clinical subtypes of uveitis. The results have demonstrated that several cytokines and chemokines are detectable in each AH, but at variable concentrations. Thus each clinical subtype of intraocular inflammation is likely to exhibit different cellular processes. Understanding which mechanisms are involved is important for improving therapeutic
options. Objectives: In this brief overview, some cytokine and chemokine pat h ways will be reviewed and the potential role(s) of immunomodulatory T cells discussed. Financial fundings: None Conflict of interest : None Keywords: chemokines, regulatory T cells, intraocular inflammation
P5-2 CX3CR1-DEPENDENT SUBRETINAL MICROGLIA CELL ACCUMULATION IS ASSOCIATED WITH CARDINA L FEATURES OF AGE-RELATED MACULAR DEGENERATION F Sennlaub, C Feumi, W Raoul, N Keller, M Rodéro, A Pézard, S Lavalette, M Houssier, L Jonet, EPicard, P Debré, M Sirinyan, P D e t e rre, T Fe rroukhi, S Cohen, D Chauva u d, JC Je a n ny, S Chemtob, FBehar-Cohen and C Combadière The role of retinal microglial cells (MC) in age-related macular degeneration (AMD) is unclear. This study shows that all retinal MC express the chemokine receptor CX3CR1 and that homozygosity for the CX3CR1 M280 allele, which is associated with impaired cell migration, increases the risk of AMD. We found that in humans with AMD, MC accumulated in the subretinal space at sites of retinal degeneration and of choroidal neovascularization. In CX3CR1deficient mice, MC accumulated subretinally with age and albino background and after laser impact preceding retinal degeneration. Raising the albino mice in the dark prevented both events. The appearance of lipid-bloated subretinal MC is drusen-like on funduscopy of senescent mice, and CX3CR1-dependent MC accumulation is associated with an exacerbation of experimental choroidal neovascularization. These results show that CX3CR1-dependent accumulation of subretinal MC evokes cardinal features of AMD. These findings reveal a novel pathogenic process with important implications for the development of new therapies.
P5-3 CHEMOKINES IN RAT EAU Wildner Gerhild (Ludwig-Maximilians-University) In Lewis rats, experimental autoimmune uveitis (EAU) can be induced with several ocular antigens, of which S-Antigen and IRBP are best characterized, including two highly pathogenic peptides, PDSAg (S-Ag, aa 341-354) and R14 (IRBP, aa 1169-1191). Immunization with these peptides in CFA as well as adoptive T cell transfer induces panuveitis in rats. The pathogenic T cells are Th1, however, despite same mRNA expression, R14-specific T cells secrete higher amounts of IFN- and TNF- than PDSAg-specific T cells. The diseases induced by these peptides are slightly different with respect to time of onset, course of disease and recurrences as well as infiltration of inflammatory cells and tissue destruction. After primary induction with peptide R14, but not with PDSAg, EAU can relapse spontaneously or can be easily reinduced experimentally. We detected further differences with respect to chemokine responses. Met-RANTES is an N-terminally modified variant of CCL5 that acts as a functional antagonist of the chemokine receptors CCR1 and CCR5 in the rat. When analyzing the effect of Met-RANTES on EAU induced by S-Ag- and IRBP-
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 9
Abstract Book peptides, we detected striking differences between PDSAg- and R14-induced uve i t i s : MetRANTES completely bl o cked EAU induced by adoptive transfer of PDSAg-, but not R14-specific T cells when injected 2-3 days after cell transfer until peak of disease, indicating an effect on T cell migration and recruitment of inflammatory cells. Mutants of MCP-1/CCL2 also revealed differences between R14- and PDSAg-specific autoimmunity, however, not to the same extent as MetRANTES: a CCL2 mutant lacking GAGbinding enhanced PDSAg-specific and suppressed R14-specific EAU, while a mutant with increased GAG-binding had an opposite effect, although both types of T cell lines expressed same amounts of CCR1-, CCR2- and CCR5-specific mRNA. Our data suggest that despite same clinical appearance, PDSAg- or R14-specific EAU are different entities of uveitis. Financial fundings: Deutsche Forschungsgemeinschaft SFB 571 Conflict of interest: (None.) Keywords: ex p e rimental autoimmune uveitis, rat model, chemokine
P5-4 Th17 vs. Th1 effector responses in EAU Dror Luger1, Phyllis B. Silver1, Jun Tang1, Daniel Cua2, Zoe Chen2, Yoichiro Iwakura3, Edward P. Bowman2, Chi-Chao Chan1 and Rachel R. Caspi1. 1Laboratory of Immunology, NEI, NIH, and 2DNAX, Palo Alto, CA and 3University of Tokyo, Tokyo, Japan. Experimental autoimmune uveitis (EAU) represents autoimmune uveitis in humans. We examined the role of the IL-23/IL-17 pathway in EAU by using knockout mice and neutralizing antibodies to target components of this pathway. To elicit disease by immunization with the retinal Ag IRBP in CFA IL-23 but not IL-12 was essential and nonredundant. IL-17 played a dominant role in pathogenesis and its neutralization prevented as well as reversed disease. Interestingly, severe EAU was induced with a polarized Th1 cell line independently of host IL–17, suggesting that a Th1 effector can be sufficient to induce the full picture of EAU. Furthermore, induction of EAU with IRBP-pulsed mature dendritic cells required generation of an IFN-Á-producing effector and an IL-17 response by itself was insufficient to elicit pathology. In keeping with this and in contrast to antibody neutralization data, genetic deficiency of IL17 did not abrogate EAU susceptibility. Thus, unlike IL-23, the role of IL-17 can sometimes be redundant, whereas a Th1 effector can be sufficient or necessary. We propose that uveitis can be driven by Th17 as well as by Th1 effector cells and that the conditions of initial exposure to the auto-Ag affect the predominant effector phenotype. These results help to provide balance to the current Th1 vs. Th17 paradigm and raise the possibility that the requirement for IL23 in EAU may extend beyond its role in promoting the Th17 effector response. The data also point to IL-23 and IL-17 as potential new targets for some types of uveitis.
P5-5 CD4+CD25+ TREGS IN MOUSE EAU Grajewski Rafael S (University Eye Clinic, Wuerzburg, Germany) Introduction and objectives: "Natural" CD4+CD25+ regulatory T cells (T-reg) develop in the thymus, apparently as a result of interaction with their cognate antigen. Susceptibility to experimental autoimmune uveitis (EAU), a model for human uveitis induced in mice with the retinal antigen interphotoreceptor retinoid-binding protein (IRBP), is controlled by T reg cells. To examine whether
endogenous expression of IRBP is necessary to generate these T reg cells, we studied responses of IRBP knockout (KO) versus wild-type (WT) mice. Methods: CD25+ cells were depleted by treatment with the monoclonal antibody PC61. Mice were immunized with IRBP in complete (CFA) or incomplete (IFA) Freund’s adjuvant, or were given T cells from IRBP-immunized donors. EAU scores and associated immunological responses (delayed hypersensitivity and proliferation to IRBP) were examined. Results: Unexpectedly, not only WT but also IRBP KO mice immunized with a uveitogenic regimen of IRBP in complete Freund's adjuvant (CFA) exhibited CD25+ regulatory cells that could be depleted by PC61 treatment, which suppressed development of uveitogenic effector T cells and decreased immunological responses to IRBP. These EAU-relevant T reg cells were not IRBP specific, as their activity was not present in IRBP KO mice immunized with IRBP in incomplete Freund's adjuvant (IFA), lacking mycobacteria (whereas the same mice exhibited normal T reg cell activity to retinal arrestin in IFA). Conclusions: Our results suggest that although endogenous expression of IRBP is needed to generate IRBP-specific T-regs, EAU-relevant T-regs are present in IRBP KO mice. We propose that mycobacterial components in CFA activate T reg cells of other specificities to inhibit generation of IRBP-specific effector T cells in a bystander fashion, indicating that effective T reg cells can be antigen nonspecific. Financial fundings: National Eye Institute, Bethesda, USA Deutsche Forschungsgemeinschaft (DFG), Germany Conflict of interest: None Keywords: Tregs, Uveitis, IRBP
P5-6 REGULATORY T CELLS IN ACAID Stein-Streilein Joan (Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School) The study of T regulatory cells began more than 30 years ago but fizzled out because the ideas were ahead of the technology. Current technology and attitudes have new interest in T cell regulation of the immune responses. The eye is an immune privileged site with unique mechanisms for the prevention of damaging immune inflammation. The immune responses that occur locally in the eye are able to protect against infectious agents in the absence of inflammation. The eye fashions its T regulatory cells in novel ways to prevent immune inflammation both locally and systemically. Specialized F4/80 antigen presenting cells (APC) within the eye carry locally inoculated antigen to the marginal zone in the spleen where they present the eye-inoculated antigen to T cells, NKT cells and B cells within an ad hoc immunosuppressive environment reminiscent of immune privileged site. The study of a model immune privileged mechanism of the eye called anterior chamber associated immune deviation (ACAID) shows that antigen specific afferent CD4+ CD25neg, FoxP3 neg T and CD4+ CD25+ FoxP3+T cells regulate the induction of immune responses and CD103+ CD8+ FoxP3 + Treg cells regulate the effector cells during an immune response. Understanding the mechanisms of immune privilege may lead to novel therapies for immune inflammatory diseases. Financial fundings: This work is supported by NIH grants EY 11983 and EY 016476 Conflict of interest: (None.) Keywords: ACAID, T reg cells, Tolerance
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 10
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P5-7 IMAGING TECHNIQUES APPLIED TO LEUKOCYTE SUBSET TRAFFICKING AND EFFECTOR FUNCTION IN EAU Liversidge Janet (University of Aberdeen Institute of Medical Sciences) , Xu Heping (University of Aberdeen Institute of Medical Sciences), M a n ivanan Ay ya k k a n nu (Radiology, Unive rsity of Aberdeen), Pop-Fanea Laura (University of Aberdeen Institute of Medical Sciences), Crane Isabel (University of Aberdeen Institute of Medical Sciences) Non-invasive in vivo imaging techniques are increasing being used for diagnosis and to understand and monitor disease processes. Aberdeen has been at the forefront of biomedical imaging and in particular the development of ocular imaging technology. We are adapting technological advances in clinical imaging methods and applying these to experimental rodent models of ocular inflammation such as EAU. Scanning laser ophthalmoscopy has been used for in vivo leucocyte subset tra ffi cking studies, c o n fo c a l microscopy has been used to study cellular interactions in ex-vivo retinal wholemounts, and MRI has been used to localise and measure macrophage activity and inflammatory retinal detachment. Using these techniques we have shown that selectin dependent trafficking patterns of effector Th1, Th2 and monocyte subsets differ. Monocyte adhesion to venules and diapedesis was found to be independent of a permissive endothelium and recirculation through peripheral lymphoid tissues was altered during inflammation. Confocal studies indicate that transmigration of leucocytes in vivo at sites of early inflammation in the central nervous system precedes breakdown of barrier function, and is dependent upon leucocyte adhesion to post capillary venules, and that total loss of barrier function in later disease is associated with larger accumulations of leucocytes, reductions in shear stress and loss of astrocyte structure. Monocytes are central to the inflammatory process in EAU and MRI can be used to visualise foci of monocytes within the uvea and measure retinal changes and detachments within the orbit in 3dimensions. More recent studies have indicated that manipulation of monocyte differentiation may provide more powerful immunotherapeutic options including reduction of inflammatory infiltrates, functional switching from pro-inflammatory phenotypes towards healing and resolution of inflammation. These data will be discussed in the context of new advances in imaging techniques that are now being developed to provide further information on inflammatory processes Financial fundings: The Wellcome Trust, The Cunningham Trust. Conflict of interest: None Keywords: Scanning laser ophthalmoscopy, confocal microscopy, MRI.
become more specific. We are seeing a lack of good functional immunologic assays that have relevance to human disease and genetic associations are important but may not really help in understanding underlying disease. Other factors may be equally important. Finally, we do not know what the “best” drugs to use are and who is at risk to develop a recurrence of their disease. Pharmacogenetics should help dramatically.
P6-3 WHY ARE SOME INDIVIDUALS AT GREATER RISK FOR DISEASE?: THE GENETICS OF UVEITIS Martin Tammy M, Smith R Justine, Doyle M Trudy, Goodwin A Kelley, Rosenbaum T James (Oregon Health & Science University) Genetic makeup is a risk factor for virt u a l ly every disease. Extremely rare, inherited forms of uveitis can result from known genetic mutations: familial granulomatous uveitis and arthritis, or Blau syndrome, conferred by mutations in the NOD2 gene, and ch ronic infantile neuro l ogi c, cutaneous, a rticular (CINCA or NOMID) syndrome, the most severe manifestation of a disease continuum resulting from mutations in CIAS1. Several forms of uveitis have a recognized, significant genetic component in the form of an HLA allele, even though they are not inherited in a Mendelian pattern. Acute anterior uveitis associated with spondyloarthritis is a prototype characterized by a strong association with HLA-B27. However, HLA-B27 contributes to genetic risk only in the context of other unknown genetic factors as shown by animal models and the fact that most individuals who are HLA B27-positive do not develop uveitis or spondyloarthritis. We have conducted the first genome-wide scan to identify other genetic regions with linkage to acute anterior uveitis. Our results indicate a uveitis-specific region on chromosome 9p. Other regions with overlapping linkage to uveitis and ankylosing spondylitis were identified. One candidate gene on chromosome 1, the receptor for interleukin-23, IL23R, is highly associated with inflammatory bowel disease, psoriasis, and ankylosing spondylitis. We have examined IL23R polymorphisms and found evidence for association with acute anterior uveitis as well. IL-23R is expressed by a subset of T cells known as TH17. These cells play a pivotal role in the pathogenesis of autoimmunity. In fact, biologic therapy which inhibits IL-23 has demonstrated efficacy in the treatment of either psoriasis or Crohn’s disease. Thus, these candidate gene studies, as well as fine-mapping of the unique region on chromosome 9p, will clarify the pathogenesis of uveitis and suggest new treatment modalities. Financial fundings: National Institutes of Health and Research to Prevent Blindness Conflict of interest: none Keywords: UVEITIS, GENETICS, CANDIDATE GENE
P6-2 IGNORANCE IS NOT BLISS: WHAT DO WE NOT KNOW ABOUT CLINICAL UVEITIS? Robert Nussenblatt MD MPH While much progress has been made in under standing Uveitis much remains to be done. We are dire need of a uniform appellation system and as well insuring that patient evaluations are standardized so that individual studies can be compared. As well mechanistically, while experimental models have provided us with a wealth of information while we become more sophisticated in our analyses we are seeing variances that may be important as therapies
P6-4 BEAM ME UP DR. MCCOY: HOW WILL WE DIAGNOSE UVEITIS IN THE FUTURE? Van Gelder Russell N (Washington University, St. Louis) The recognition of discrete clinical uveitic disease presentations has been the mainstay of uveitic diagnosis throughout the 20th century. With the increasing recognition of the underlying causes of uveitic diseases, diagnostic testing will continue to become more precise.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 11
Abstract Book Among the methods under development that will be discussed in this presentation are: multiplex cytokine profile analysis; 2D We s t e rn blotting combined with proteomics for autoantibody detection; pathogen polymerase chain reaction diagnostics; and genomic representation/high throughput DNA sequencing methods for identification and characterization of potential pathogens. Financial fundings: N ational Institutes of Health Burro u g h s Wellcome Trust Culpeper Clinician-Scientist Award of Rockefeller Brothers Foundation Conflict of interest: Dr. Van Gelder is a paid consultant for Alcon Research Laboratories Keywords: Diagnostics, polymerase chain reaction, inflammation
P6-5 FIRST DO NO HARM: ARE OUR CURRENT THERAPIES SAFE OVER THE LONG TERM? John H. Kempen (Philadelphia, USA) P u rp o s e : To present the approach of the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study for evaluating potential long-term adverse effects of systemic immunosuppressive therapies in patients with inflammatory eye diseases. Methods: Randomized clinical trials are the most reliable methodology for evaluating the effects of treatments on outcomes, but ethical considerations, high cost, and long duration of required followup make this approach non-feasible for the evaluation of long-term adverse effects of immunosuppression. Retrospective cohort studiesâ&#x20AC;&#x201D;more efficient in cost and timelinessâ&#x20AC;&#x201D;can only be performed if records exist that provide quality data about the issues of interest over a similar amount of follow-up time as a randomized clinical trial would need. Case-control methods, while ideal for studying risk factors for common diseases, require very large sample sizes to study the relationship between rare exposures (e.g., treatment of eye diseases with immunosuppressive medicines) and common outcomes (e.g., mortality). They also are subject to recall bias when studying mortality, because surrogates must provide details about the patients remote past. Results: The SITE Cohort Study applies the retrospective cohort design. Use versus non-use of immunosuppressive agents is ascertained from existing medical records of over 8,000 ocular inflammatory disease patients at five US centers. Mortality and cause of death data are provided by the National Death Index, providing approximately 100,000 person-years of follow-up for mortality. United States Vital Statistics provide general population mortality rates that can be compared to mortality rates of treated and nontreated ocular inflammation patients. Two-tailed detectable difference calculations suggest the study could identify an increase in risk (of mortality and of fatal malignancy respectively with respect to the general population) of 22% and 49% for antimetabolites, 36% and 81% for alkylating agents, and 28% and 62% for T-cell inhibitors. Conclusions: The SITE Cohort Study should provide valuable information regarding the issue of whether the immunosuppressive agents used in managing eye diseases increase the risk of mortality or of fatal malignancy. The study also provides a valuable opportunity to evaluate the outcomes of a large cohort of ocular inflammatory disease patients.
P6-8 YOU SAY TOMATO, I SAY...: THE IMPORTANCE OF DIAGNOSTIC CRITERIA Read Russell W (University of Alabama at Birmingham, USA) In order to advance knowledge in the field of uveitis, quality clinical research on well defined populations of patients with the same disease is required. Diagnosis of uveitis currently depends largely on history and clinical features with support from ancillary investigations such as serology, fluid analyses, and imaging. Variations in practice patterns, patient populations, and other clinician factors may result in a variation in ascribed diagnoses for similar disease, or conversely, assignment of a specific diagnosis to patients with a wide variety of clinical presentations. Diagnostic criteria are useful to define the inclusion and exclusion criteria for a particular disease entity and if applied properly, should produce a homogeneous patient population to study. This talk will outline the rationale for the development of uveitic diagnostic criteria; explore the existing criteria in uveitis; take examples of criteria implementation from other fields of medicine; and discuss the importance of developing criteria for multiple uveitic diseases. Financial fundings:Research to Prevent Blindness ; Eye S i g h t Foundation of Alabama Conflict of interest: None. Keywords: criteria, collaborative, uveitis
P7-1 SERPIGINOUS LIKE CHOROIDITIS MYCOBACTERIAL INFECTION Rao Narsing A (Doheny Eye institute)
IN
Objective: Histopathologic, Immunohistochemical and real time PCR analysis of Tuberculous uveitis Methods: Histopathologic analysis of enucleated globes with the diagnosis of Tuberculous uveitis included localization of the acidfast organisms, immunohistochemistry to identify the tissue affected by the organisms and confi rm ation of the organisms by microdissection of RPE followed by real time PCR using specific primers of the mycobacterium. Results: The acid-fast organisms were primarily localized to the necrotic RPE with secondary damage to the retina and heavy infiltration of granulomatous inflammation in the choroid. Real time PCR confirmed amplified DNA of the tuberculous organisms mainly in the RPE cells. Conclusions: One of the charecteristic clinical feature of tuberculous choroiditis is the findings simulating serpiginous choroiditis associated with signs of vitritis and positive skin test for tuberculous antigen (PPD). The above histopathologic analysis shows that the clinical features of tuberculous serpiginous -like choroiditis could be from selective invasion of RPE by the tuberculous organisms. Financial fundings: None Conflict of interest: None Keywords: Tuberculosis , RPE, uveitis
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P7-2
P7-3
RETINO-CHOROIDAL LESIONS IN BIRDSHOT CHORIORETINOPATHY
VITREOUS AND RETINOCHORO I DAL CHANGES IN WHIPPLE’S DISEASE Bahram Bodaghi, 2MD, PhD Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
Carl P. Herbort1,2 1Inflammatory and Retinal Eye Diseases, Center for Ophthalmic Specialized Care, Lausanne, Switzerland. 2University of Lausanne, Lausanne, Switzerland. Birdshot chorioretinopathy (BC) is a primary stromal choroiditis that is also characterized in addition by retinal inflammatory involvement unrelated to choroidal lesions. Therefore dual fluorescein and indocyanine green (ICG) angiography seems to be absolutely required to properly evaluate inflammatory involvement in BC. We have analysed in a previous study the choroidal and retinal involvement from early to late disease using dual fluorescein and ICG angiography that allowed us to gi ve pathophysiological hypotheses. 1. The nature of the choroidal lesions in BC has been at the origin of diffe rent conjectures. Indocyanine green angi ography has allowed imaging access to the choroid and given morphological information on lesions in choroidal inflammatory disease. Our study has shown that choroidal lesions in early BC were characterized by well apparent hypofluorescent dark dots in all patients associated with choroidal vasculitis in severely inflamed cases. The ratio of ICGA hypofluorescent dots to cream colored depigmented birdshot fundus lesions was high in early disease with scarce or no cream-colored depigmented lesions visible in recently diagnosed cases, whereas this ratio was low in late treated disease, characterized by disappearance of ICGA hypofluorescent areas (except the hypofluorescences of chorioretinal atrophy), an indication of good choroidal response to treatment. In late treated patients with prolonged follow-up, progressive disappearance of hypofluorescent lesions could be followed from year to year. 2. As far as retinal lesions were concerned both large and small vessel inflammation was noted that persisted in the long term and responded poorly to treatment in a large proportion of cases. The following conclusions were drawn : in early BC disease dense cellular infiltrations in the choroidal stroma produce a mass effect that impairs filling by the ICG dye causing hypofluorescent dots on ICG angiography. In the late post-therapeutical or burned out phase of the disease, cellular infiltration has regressed leaving areas deprived of choroidal pigment that produce the cream colored depigmented lesions seen on fundus examination. On the other hand retinal vasculitis is poorly influenced by therapy and is at the origin of the deleterious evolution that is observed by fluorescein angiography and is at the origin visual field impairment. These hypotheses have recently been verified by the report of an autopsy case of late BC showing scanty lymphocyte infiltrations explaining the hypofluorescent dark dots seen on ICG angiography in early disease and at the origin of melanocyte loss appearing as the cream colored depigmented birdshot lesions. It also showed severe retinal perivascular infiltration at the origin of retinal disease.
First reported in 1907, Whipple's disease is a rare infectious disease caused by a gram-positive bacterium, Tropheryma whipplei. Its classic symptoms are diarrhea and arthralgias, but symptoms can be various. Rarely, cardiac, central nervous system or ocular involvement, not always associated with digestive symptoms, may also be observed. Panuveitis with predominant vitritis and posterior segment manifestations such as retinal vasculitis, macular edema and papillitis remain the usual manifestations. Diagnosis has been based on duodenal biopsy, which is positive using periodic acidSchiff staining. However, for patients without digestive symptoms, results can be negative, leading to a delay in diagnosis. Molecular analysis of ocular fluids is now routinely performed. More recently, bacterial culture has also been reported. The natural evolution of the disease without treatment is always fatal. Current treatment is based on administration of trimethoprim-sulfamethoxazole for at least 1 year. We have studied a case of chronic and relapsing diarrhea associated with recent panu veitis in a Caucasian male. Molecular tools confirmed the diagnosis of Whipple’s disease. Interestingly, the bacterial agent was identified in blood and vitreous mononuclear cells, suggesting hematogenous spread at the origin of ocular invasion. After specific antibacterial treatment, infected blood cells were no more detected. Despite its low incidence, Whipple’s disease should be excluded in patients with chronic uveitis evocative of an infectious etiology, even in the absence of extra-ocular signs.
P7-4 UVEITIS AND XANTHOGRANULOMATOUS INFILTRATION Frédéric CHARLOTTE, Department of Pathology, Pitié-Salpêtrière Hospital, Paris France Xanthogranulomatous lesion is a chronic granulomatous inflammation made up of histiocytes, epithelioid cells, giants cells admixed with lipid-laden foamy macrophages. The main intraocular xanthogranulomatous lesion is juvenile xanthogranuloma (JVX) which should not be confused with other histiocytosis which can harbor lipid laden-macrophages such as Langerhans cell histiocytosis (LCH), Rosai-Dorfman disease (RDD) or necrobiotic xanthogranuloma (NXG). From a histological point of view, other intra-ocular lesions with lipid-laden macrophages such as endophthalmitis, Whipple’s disease, phagolytic glaucoma could constitute a differential diagnosis with NXG but the diagnosis of these lesions can be easily established without biopsy by a purely clinical approach for phagolytic glaucoma or by bacteriological methods for endophthalmitis or Whipple’s disease. JVX has a bimodal distribution (<1y, 20-30 y) but can also be diagnosed in adults. The main JVX site is the skin but the eye can also be affected in less than 0.5% of cases. Intraocular lesion can be isolated, skin lesions appearing 8-10 months later. Clinically, JVX is an anterior uveitis presenting as yellowish nodules or diffuse thickening of the iris with heterochromia. Spontaneous hyphema can occur and result in secondary glaucoma or corneal opacification. Histologically, JVX is characterized by an infiltrate of histiocytes
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 13
Abstract Book with foamy cytoplasm admixed with Touton-type giant cell. JVX histiocytes are CD68+, FXIIIa+, S-100-, CD1a-. Intra-ocular LCH can be a possible differential diagnosis of JVX. Intra-ocular lesions have been described in 10% of systemic LCH. Only 4 cases of intra-ocular LCH without systemic manifestation masquerading as uveitis have been reported to date. Histologically, LCH is a Langerhans cell proliferation admixed with eosinophils and lymphocytes. LCH cells are CD68+, S-100-, CD1a+, FXIIIa-, langerin+, electron microscopy demonstrating Birbeck granules in their cytoplasm, a specific marker of LCH. Ophthalmic manifestation has been described in 28%-43% of RDD but uveitis is rare since only 20 cases have been published to date. These RDD cases mainly manifested as anterior uveitis and were always associated with skin lesions or lymphadenopathies. RDD cells are CD68+, S-100+/-, CD1a-. NXG is a histiocytic proliferation with foamy macrophages, cholesterol clefts and necrosis of collagen tissue. NXG cells are CD68+, S-100-, CD1a-. NXG is associated with paraproteinemia, myeloma or carcinoma. Clinically, NXG consists of indurate yellow-brownish skin lesions in the periorbital area. Orbit localization is the main ophthalmic manifestation of NXG, uveitis being described in only one publication without histopathological proof. Conclusion: Juvenile xanthogranuloma, the main intraocular xanthogranulomatous lesion masquerading as uveitis, should not be confused with Langerhans cell histiocytosis, Rosai-Dorfman disease or necrobiotic xanthogranuloma. The diagnosis generally relies on skin biopsy for JVX, RDD, LCH and NXG, or lymph node examination for RDD. In case of isolated intraocular lesion, iris biopsy, more rarely eye enucleation, may be required.
immunoglobulin gene in primary retinal tumour cells. Our data indicate that (1) there are differences in the expression patterns of immunoglobulin transcription factors between primary retinal lymphomas/PCNSL and peripheral DLBCL; and (2) the majority of primary retinal lymphomas show numerous somatic mutations in the VH region. The data support the notion that peri p h e ral and centra l ly located DLBCL differ in clinical, immunophenotypic and genotypic features, despite similar morphological characteristics. Further, they suggest that primary retinal lymphoma are derived from mature B-cells that have undergone a prolonged interaction in the germinal centre, and are either at the late germinal centre stage of differentiation or are early post-germinal centre B-cells. Financial fundings: None Conflict of interest: None Keywords: intraocular, retinal, lymphoma
P8-1 MOLECULAR PATHOLOGY OF AMD : INFLAMMATION & NEOVASCULARIZATION Chan Chi-Chao (National Eye Institute) Age-related macular degeneration (AMD) is the most common cause of blindness in Western countries. Susceptibility is influenced by age, genetic and environmental factors. AMD pathology is characterized by degenerative changes of photoreceptors, RPE, Bruch’s membrane, and less prominently, choroidal capillaries. Early AMD includes drusen and advanced AMD includes geographic atrophy (‘dry’) and choroidal neovascularization (‘wet’).
P7-5 UVEITIS IN LYMPHOPROLIFERATIVE DISORDERS Coupland Sarah E (Dept. of Pathology, University of Liverpool, UK), Damato E Bertil (LIverpool Ocular Oncology Centre, Royal Live rpool Unive rsity Hospital), Hummel Michael (Dept. of Pat h o l ogy, Charité University Hospital, Benjamin Franklin, Berlin), Stein Harald (Dept. of Pathology, Charité University Hospital, Benjamin Franklin, Berlin) Neoplastic masquerade syndrome is defined as neoplastic lesion that causes intraocular cellular infiltration, simulating immunemediated uveitis. The most frequent neoplastic masquerader is primary retinal lymphoma, a high-grade B-cell lymphoma that demonstrates a very aggressive course with cerebral disease in most patients. Less common lymphoid malignancies with signs similar to uveitis include primary choroidal lymphoma, primary iridal lymphoma or secondary intraocular infiltration of a systemic lymphoma. In contrast to primary retinal lymphoma, primary uveal lymphoma are rarely associated with CNS disease. Primary retinal lymphoma should be excluded clinically in elderly patients presenting with chronic steroid-resistant uveitis. Cytological examination of vitreous specimens remains the first line investigation in excluding neoplastic disease in patients with idiopathic chronic uveitis. Although associated with higher morbidity, chorioretinal biopsies increase the chances of diagnosing or excluding intraocular lymphoma. IgH-PCR and TCR-Á-PCR prove to be useful adjuncts in diagnosing intraocular lymphoma. We studied the expression of immunoglobulin transcription factors in primary retinal lymphoma and PCNSL tumour cells, and compared the results with peripheral DLBCL. We analyzed the VH usage and number of somatic mutations in the complementaritydetermining region (CDR) 2 and framework region (FR) 3 of the
Localization of inflammatory elements such as complements, macrophages and microglia in AMD lesions support the hypothesis that local inflammation, activation of the complement cascade, and, possibly, the immune system contribute to the pathogenesis of AMD. Further support for this hypothesis comes from conclusive evidence that variants in CFH influence susceptibility to AMD. Variants in FB, C2, or C3 also appear to influence susceptibility to AMD. Associations of other inflammatory factors such as CX3CR1 or TRL4 and AMD have been documented. Low CX3CR1 expression and correlated genotypes are detected on archived eyes with AMD. Neovascularization is the hallmark of wet AMD. The most promising drugs to emerge from recent clinical trials inhibit the effects of vascular endothelial growth factor (VEGF) and its re c ep t o r. Increases of VEGF protein and transcripts are evident in the neovascular AMD lesions. VEGF polymorphisms are also reported to be associated with wet AMD. Molecular pathology is complementary to case-control cohorts that confirm genetic involvement in AMD. This information helps to determine disease pathogenesis. Studies of gene-gene and/or geneenvironmental interaction, including molecular pathology, will help to improve prevention and treatment of AMD. Financial fundings: NEI Intramural Research Program Conflict of interest: none Key wo rd s : age - re l ated macular dege n e ration, pat h o l ogy, ge n e polymorphism
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 14
Abstract Book
P8-2 G E N E - E N V I RONMENT INTERACTION IN PRO G R E SSION OF AGE RELATED MACULAR DEGENERATION (AMD) Baird Paul N (Centre for Eye Research Australia) Robman D Luba (Centre for Eye Research Australia), Richardson J Andrea (Centre for Eye Research Australia), McCarty A Catherine (Marshfield Clinic Research Foundation, USA), Guymer H Robyn (Centre for Eye Research Australia) Introduction and objectives: A number of risk factors including the complement factor H (CFH) gene, smoking as well as C. pneumonia have been shown to be associated with age related macular degeneration (AMD). However, the mechanisms underlying how these risk factors might be involved in both disease progression and aetiology is poorly understood. Methods: A cohort series of 233 individuals from a single centre were followed over a mean period of 7 years. All individuals underwent a full eye examination, blood was taken for DNA and antibody titre, and individuals completed a standard medical and general questionnaire. Y402H variants of the CFH gene were assessed with disease progression as well as e xamination of interaction between Y402H variants and smoking and Y402H variants and the pathogen C. pneumonia. Results: The CC risk genotype of Y402H was significantly associated with increased progression of AMD (odds ratio (OR) 2.43, 95% confidence interval (CI) 1.07, 5.49). Smoking was also significantly associated with AMD progression (OR=2.28 95% CI 1.264.12.). However, the risk of progression was greatly increased to almost 12 fold (OR 11.8, 95% CI 2.1-65.8) when, in addition to having the C risk allele, subjects presented with the upper tertile of antibodies to the bacterial pathogen C. pneumoniae compared to those with the T allele of Y402H and the lowest antibody tertile. Conclusion: We demonstrate for the first time the existence of a gene environment-interaction between pathogenic load of C. pneumoniae and the CFH gene in the aetiology of AMD. This provides novel insights into the mechanisms involved in the pathogenesis of this disease and offers the potential for substantial advances in disease management. Financial fundings: JACOM Foundation, Ophthalmic Research Institute of Australia, Royal Victorian Eye & Ear Hospital Research Committee Conflict of interest: none Keywords: gene, pathogen, interaction
P8-3 ROLE OF COMPLEMENT AND COMPLEMENT REGULATORY PROTEINS IN AGE-RELATED MACULAR DEGENERATION Bora Nalini S, Bora S. Puran (University of Arkansas for Medical Sciences) Introduction and objectives: Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among the individuals over the age of 55. Although the non-exudative (dry) form of AMD is more prevalent, catastrophic vision loss is more frequently associated with the exudative (wet) form, specifically from the complication of choroidal neovascularization (CNV). This study was undertaken to understand the role of complement in AMD.
Methods: CNV was induced by laser photocoagulation in C57/BL6 mice. The animals were sacrificed at various time points post-laser and RPE-choroid-scleral flat mounts were analyzed under confocal microscope to detect the development and severity of CNV. RPE-choroid-scleral tissue was also harvested for RTPCR, Western blot analysis and ELISA to determine the expression of various growth factors, complement components and complement regulatory proteins (CRegs). Results: Our studies have demonstrated precisely the role played by complement and complement activation pathways in the development of wet-AMD. In addition, our studies described the first direct role of complement activation and membrane attack complex (MAC) formation in the mouse model of laser- induced CNV. We have further demonstrated that MAC formation via the alternative pathway activation, but not the classical or lectin pathway, is important for the release of angiogenic growth factors that are critical for the generation of CNV complex in mouse model. Our recent findings provide strong evidence that CD59 (regulator of MAC formation) plays a crucial role in regulating MAC mediated release of growth factors that drive the development of laserinduced CNV in mice. Conclusion: The data from our laboratory clearly implicates MAC as a major mediator of CNV in the murine model, thus, providing a rationale for the inhibition of MAC assembly by recombinant CD59 as a novel therapeutic alternative to current treatments. Financial fundings: NIH EY13335, EY014623, EY016205, Research to Prevent Blindness NY and the Pat & Willard Walker Eye Research Center, Jones Eye Institute, University of Arkansas for Medical Sciences (Little Rock, AR) Conflict of interest: None Key wo rd s : Age-related macular degeneration, Complement, Complement regulatory proteins
P8-4 Neovascularization & AMD: pathogenesis Chong Victor (King's College Hospital, London and Oxford Eye Hospital, Oxford) Introduction: Age-related macular degeneration (AMD), in particular, the neovascular form, is the leading cause of blindness in the developed world. Recent anti-angiogenic therapy of neovascular AMD has improved the visual outcome, nonetheless, the treatment is invasive and expensive. Prevention of the formation of neovascularization is the key for future reduction in visual loss. Methods and Results: The pathogenesis of neovascular AMD remains poorly understood. The retinal pigment epithelium (RPE) can be injured by numerous causes, such as blue light, and smoking; certain “at risk” polymorphisms of complement factors may alter the injury response, allowing more cellular damage. The accumulated cellular dysfunction is leading to the built up of material in the Bruch’s membrane as well as destroying the defensive elastic layer in the Bruch’s membrane. The thickening of the Bruch’s membrane reduces the oxygen transport from the choroid to the RPE, which leads to relative hypoxia. This hypoxia induces several cellular cascades leading to angiogenesis. The budding new vessel from the choroid requires making its way through the Bruch’s membrane to invade the retina. In most part of the retina, the elastic layer prevents the invasion of the new vessel as this layer is difficult to digest and break through. However, in the macular region, the elastic layer is fragile, and in patients in AMD, it is further degraded. This relative weakness leads to neovascular AMD and
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 15
Abstract Book often severe visual loss. Conclusion: The pathogenesis of AMD is complex and multi-factorial. This can be seen as a challenge but at the same time as an opportunity. It is possible that by blocking one aspect of the pathway, the whole process can be halted. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Macular degeneration, choroidal neovascularization, pathogenesis
had led to vision improvement in a substantial number of patients. Bevacizumab, also directed against VEGF, was tried in patients and seemed to be comparable in small series, and additional studies are investigating this and other anti-VEGF approaches. These antiVEGF therapies have changed the paradigm and the expectations for treatment. Further work combining available and developing therapies, including anti-VEGF, photodynamic therapy, and antiinflammatory and neuroprotective agents, may lead to even better results for patients. At a more fundamental level, investigators are working to identify genes and molecular pathways that may be targeted throughout the disease process, and in particular at the earliest stages
P8-6 NEOVASCULARIZATION & AMD: INNOVATIVE THERAPY Wolf Sebastian (Klinik und Poliklinik fĂźr Auge n h i e l k u n d e, University Bern, Switzerland) New innovative strategies for the treatment of exudative AMD include anti-VEGF agents and combination therapy. Anti-VEGF therapy has significantly changed the management of neovascular AMD and other retinal vascular diseases. Currently, several drugs that inhibit the action of VEGF are clinically used. These include ranibizumab and bevacizumab. Whereas ranibizumab (Lucentis) has been approved for the treatment of exudative ARMD in the EU, bevacizumab (Avastin) is not approved for ophthalmic use. AntiVEGF therapy improves visual acuity in about one third of patients with exudative AMD, but requires repeated injections for a long time. Therefore, combination therapy of anti-VEGF drugs with photodynamic therapy is under evaluation. Several pilot studies have demonstrated that combination therapy results leads to similar visual outcomes as anti-VEGF therapy alone, but reduces the number of re-treatments. Data on combination therapy will be presented and future therapeutic strategies discussed. Financial fundings: (None.) C o n flict of intere s t : Novartis AG, Pfizer Inc. , Allergan, MediGene AG Keywords: ARMD, anti-VEGF, neovascularization
P8-7 NEOVASCULAR AMD; PAST PRESENT AND FUTURE Miller Joan W (Massachusetts Eye & Ear Infirmary) Age related macular degeneration is a major public health problem affecting millions of men and women in developed countries. Treatments for the neovascular form of AMD have advanced from early ablative therapy to therapies based on biologic principles. In the 1980â&#x20AC;&#x2122;s through the end of the century, clinicians relied on laser photocoagulation to ablate and limit choroidal neovascularization. Frequent recurrences progressed inexorably to the fovea, and subfoveal treatment resulted in immediate and substantial vision loss. In 2000, verteporfin photodynamic therapy, combining a photosensitive drug and laser activation was introduced, and for the first time a pharmacologic therapy was able to slow and limit the progression of vision loss in patients with neovascular AMD. Investigators were concurrently developing anti-angiogenic therapies, particularly those directed against vascular endothelial growth factor, or VEGF. The first of these, pegaptanib, was introduced in 2004, representing the first demonstration of the effectiveness of anti-angiogenic therapy in ocular disease. In 2005, clinical trials using ranibizumab showed nearly all patients avoiding moderate vision loss, and more dramatically, a third of patients experienced moderate vision gains. This was the first time a therapy for AMD
Financial fundings: None Conflict of interest: QLT Phototherapeutics, Inc Bausch & Lomb, Inc Genentech, Inc Genzyme Keywords: Macular Degeneration, Vascular endothelial growth factor, Neovascularization
P9-1 EXPERIMENTAL ALLERGIC CONJUNCTIVITIS IN RATS AND MICE: IMPLICATIOONS FOR HUMAN ALLERGIC CONJUNCTIVITIS Fukushima Atsuki (Kochi Medical School) Introduction: Ocular itching and hyperemia without significant infiltration of inflammatory cells in the conjunctiva are the most common features of mild forms of allergic conjunctivitis (AC). However, massive infiltration of eosinophils is noted in severe AC, such as vernal keratoconjunctivitis. Although AC is an Ag-specific disease, eosinophils do not have Ag-specific receptors. Therefore, we hypothesized that T cells might play a crucial role in conjunctival eosinophil infiltration and therefore, investigated the role T cells play in the development of experimental AC (EC) by using rats and mice. Methods: EC was induced in rats and mice by either active or passive immunization followed by conjunctival challenge with the same Ag used for immunization. With regard to passive immunization, Ag-specific IgE or Ag-primed T cells were transferred into syngeneic recipient animals. To investigate the importance of T cells in the development of EC, immunosuppressants, such as CsA or FK506, were topically applied in EC-developing mice. To investigate the importance of T-cell activation in the development of EC, Abs against T cell-related co-stimulatory molecules (TNF-receptor family) were intraperitoneally injected into EC-developing mice. Results: EC, evaluated by conjunctival eosinophil infiltration, was induced in rats and mice by active immunization. The transfer of Ag-primed T cells, but not A g - s p e c i fic IgE, induced EC. Furthermore, the transfer of Ag-specific Th2 cells, but not Th1 cells, induced EC. Topical application of CsA or FK506 abolished EC. These data confirmed that T cells play a crucial role in the development of EC. An investigation using Abs against co-stimulatory molecules revealed that agonistic stimulation of 4-1BB suppressed EC, while agonistic stimulation of OX40 exacerbated EC. The data suggested that T cell activation is essential for the development of EC Conclusions: Our data indicates that T cells, especially Th2 cells, predominantly participate in conjunctival eosinophil infiltration of EC. Moreover, it was revealed that Financial fundings: (None.) Conflict of interest: (None.)
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 16
Abstract Book Keywords: allergic conjunctivitis, T cells, eosinophils
P9-2 THE PHENOTYPE AND FUNCTION OF DENDRITIC CELLS IN ALLERGIC EYE DISEASE Manzo u ri Bita (Moorfields Eye Hospital & Institute of Ophthalmology ) , Fattah Dilniya (GlaxoSmithKline Medicines Research Centre), Ohbayashi Masaharu (Emory Eye Center, Emory Unive rs i t y ) , Leonardi Andrea (Ophthalmology Unit, Department of Neuroscience, University of Padua), Larkin Frank (Moorfields Eye Hospital & Institute of Ophthalmology), Ono J Santa (Emory Eye Center, Emory University) Dendritic cells (DCs) are critical components of the immune system owing to their role in the induction and control of T-cell immunity and the initiation of the ocular allergic response. Studies in the bronchial tree of asthma patients and in the lesional skin of atopic dermatitis patients have suggested that DCs from these allergic patients have an increased immunostimulatory capacity which may be due to upregulation of the high affinity receptor for IgE (FceRI). The aim of this study was to compare the differences in the phenotype and function of peripheral blood derived and resident tissue DCs in patients with vernal keratoconjunctivitis (VKC) and healthy control subjects. Dendritic cells were derived from monocytes in peripheral blood and stained with monoclonal antibodies to various cell surface markers and expression quantified using flow cytometry. Resident tissue DCs were identified using immunohistochemistry with conjugated antibodies to known DC cell surface markers. Allogenic mixed leukocyte reaction assays were then performed to assess the ability of DCs derived from VKC patients versus those derived from non-atopic donors to stimulate T cell proliferation. The results indicate that DCs from atopes may be in a more mature state of differentiation, as reflected in the upregulation of their costimulatory molecules, but not of FceRI, although this receptor was significantly upregulated in resident conjunctival tissue DC. This more mature state of existence did not make the VKC DCs more potent at stimulating T cell proliferation into either the Th1 or Th2 phenotype. This may indicate one of three possibilities: these DCs may be inducing T regulatory cell proliferation; there may be a fault in the T cell response to proliferation signals derived from the DC; or there is an intrinsic failure of the DCs to stimulate an adequate proliferation response in the T cells. Financial fundings: Medical Research Council GlaxoSmithKline Conflict of interest: None Keywords: Eye, Allergy, Dendritic cells
late cases associated with bleb leakage. Experience from Sweden, however, points to the possibility of reducing these incidences through the use of intracameral prophylaxis. Gram-positive bacteria ori gi n ating from the pat i e n t s ’ own fl o ra d o m i n ate as causes, with stap hylococci being the most common ones after cat a ract surge ry and streptococci after filtrating surge ry and corneal transplants. The shift away from traditional causative organisms when using intra c a m e ral antibiotics attest to their effi c acy. In Swe d e n , enterococci, being resistant to cefuroxime wh i ch is the pre fe rred intra c a m e ral antibiotic, has become the no.1 aetiology. Conclusion: Future preventive measures should draw on conclusive large scale studies like those emerging from the National Cataract Register in Sweden Financial fundings: None Conflict of interest: None Keywords: endophthalmitis
P10-2 INFLAMMATO RY EVENTS AND DESTRU C T I V E PROCESSES OF INFECTIOUS ENDOPHTHALMITIS Bahram Bodaghi, MD, PhD Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France Endophthalmitis remains a blinding complication of ocular surgery, systemic bacteraemia or candidemia. Microbial replication is the main cause of devastating consequences leading to visual loss in patients with infectious endophthalmitis. However, pathogenicity is not only linked with toxin production during infection. Retinal toxicity may be also due to immune mediated mechanisms. Bacterium-host interactions seem highly important for the pathogenesis of these infectious conditions. Host immune status and molecular alterations of immune components involved in the homeostasis of ocular tissues may be involved. Toll-like receptors (TLR) are an essential component of the innate and adaptive immune response. They are responsible for the recognition of different pathogens and trigger responses directed at eliminating these agents as well as the development of immunological long-term memory. Lipopolysaccharide of Gram negative bacteria may activate different types of TLR. This antimicrobial mechanism may be altered and overburdened during infection, especially when bacterial load becomes important. Different experimental models have been developed in order to evaluate the role of immune mediated mechanisms in the pat h ogenesis of retinal destru c t i o n . Interestingly, in the mice model of bacillus endophthalmitis, polymorphonuclear leukocyte infiltration into the vitreous began as early as 4 hours after infection and induces a significant increase in intraocular levels of TNF-alpha. The better understanding of bacterium-host interactions may determine new therapeutic strategies and improve visual prognosis in patients with endophthalmitis.
P10-1 Epidemiology and aetiologies Montan Per (St Erik Eye Hospital)
P10-3 Risk factors and prophylaxis – is there an interplay?
Introduction: Post-operative endophthalmitis remains a feared but fortunately rare complication. Results: The reported incidence figures vary. Recent data regarding cataract surgery indicate a rate on the rise, e.g. in the USA, 0.2%. For transplant surgery and for penetrating filtrating surgery, the generally reported rate seems stable and a little higher, roughly 0.4% each, but regarding the latter, the incidence is burdened by
Wejde Gisela (St Erik Eye Hospital) Introduction: Risk factors for endophthalmitis following cataract surgery has been studied extensively. Results: Patient age, diabetes, silicone lenses, the non-use of injectors, clear corneal incisions and pero p e rat ive capsular bre a k age are
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 17
Abstract Book some independent factors that have been identifi e d. Results have been contradictory, though, p ro b ably due to va rying sample sizes and s t u dy designs. Ideally, data should be collected in a prospective manner with as little va ri ability as possible in terms of pre - o p e rative prophylaxis, a factor that in itself constitutes an important decisive factor. In a re c e n t ly published prospective endophthalmitis study in Sweden, 225 000 cat a ract surgeries and 109 cases of endophtahlmitis we re regi s t e re d. High age, capsular bre a k age and the non â&#x20AC;&#x201C;use of intra c a m e ral cefuroxime we re identified risk factors for infection. In c o n t rast to results of other mu ch smaller studies, incision type, use of i n j e c t o rsor lens material we re not found to be predictors of infection. Conclusion: Ideally, risk factor analyses should be performed in a prospective, large-scale setting with as little variabilty as possible in terms prophylaxis as possible. Financial fundings: none Conflict of interest: none Keywords: endophthalmitis
P10-4 LENS MATERIAL, BACTERIAL ADHESION AND ENDOPHTHALMITIS. EXPERIMENTAL AND CLINICAL DATA KODJIKIAN Laurent (Department of Ophthalmology, Croix-Rousse University Hospital, Claude Bernard Lyon I University, Lyon, France ) Postoperative endophthalmitis following intraocular lens (IOL) implantation is still one of the most feared complications of cataract surgery. Bacterial adhesion to IOLs during their insertion is a prominent etiological factor. Following adhesion, bacteria replicate, congregate and f orm multiple layers of microcolonies which actually represent the basic structural unit of the biofilm. The bacteria are embedded in a slime layer. This slime matrix is not only an adhesive medium; it also affects virulence. Adhesion to IOLs has been studied by several in vitro studies and discrepancies can be found between them which are due to variations of experimental conditions (strains, incubation times, methodsâ&#x20AC;Ś). Adhesion is affected by the nature of the IOLs, the isolates and the surrounding medium. Therefore, we developed a novel in vitro model to study Staphylococcus epidermidis biofilm formation on IOLs from the primary attachment phase to the biofilm accumulation one. The model was designed to replicate intraocular conditions especially by taking into account intraocular hydrodynamic conditions. We obtained the kinetics of biofilm growth on IOLs. It could be described in 3 phases: a latent phase, a dynamic or accelerated growth one and a linear growth one. Furthermore, the extent of bacterial binding to IOLs was found to range in increasing order from the hydrophilic acrylic polymer, to PMMA, hydrophobic acrylic and silicone. Nevertheless, the best model remains in vivo one, but it is time and money consuming. There have been few epidemiological studies published to determine the re l ationship betwe e n endophthalmitis and the IOL type. Silicone IOLs have been recently accused in the recent ECSRS multicentre study. Finally, the perfect biomaterial that could prevent postoperative endophthalmitis does not yet exist. Globally, hydrophilic materials and hydrophobic acrylic seem to be less sticky than silicone or PMMA, but this remains to be strongly proven clinically. Financial fundings: none Conflict of interest: none Keywords: endophthalmitis, bacterial adhesion, lens material, bio-
material
P10-5 MEDICAL TREATMENT. ARE THE EVS DATA STILL VALID ? Cochereau Isabelle (CHU Angers) In bacterial endophthalmitis, antibiotics remain the main treatment. They must be started as soon as possible after the diagnosis is suspected. A broad-spectrum antibiotherapy is required since the causative organism is not known when the antibiotherapy is started: gram-positive organisms (especially coagulase-negative) are the most frequent (90%), gram-negative organisms (10%) are less frequent but they cause very severe endophthalmitis. Intravitreal antibiotics are mandatory since the vitreous is the key compartment, topical antibiotics are optional and systemic antibiotics are still controversial. Initially, an intravitreal injection of two antibiotics is performed: vancomycin still efficient on gram-positive organisms, combined with either amikacin with the risk of macular toxicity, or ceftazidime with the risk of intravitreal precipitation. One or two intravitreal injections performed within the first week are usually sufficient. In case of further deterioration due to a gram-negative o rga n i s m , a sw i t ch to ceftazidime-amikacin or ceftazidimetobramycin might be useful. Fortified topical antibiotics are indicated only to treat an associated superficial abscess, but they do not kill intravitreal organisms. Commercially available topical antibiotics are prescribed to decontaminate the ocular surface during the first week. Systemic therapy is still controversial. If used, a 5-to-8 day combination of antibiotics with favourable intraocular kinetics like intravenous imipenem and a new fluoroquinolone can be used. A pro m p t , wide spectrum and bactericidal initial intrav i t re a l antibiotherapy remains the key initial tre atment in bacterial endophthalmitis. Its association with other routes of administration will depend on the severity of the infection, nature of the organism, and response to therapy. Financial fundings: None Conflict of interest: None Keywords: Endophthalmitis, antibiotics, intravitreal injections
P10-6 VITRECTOMY. ARE THE EVS DATA STILL VALID? Marc D. de Smet D ivision of Vitreoretinal surge ry, ZNA Middelheim Campus, Antwerp, Belgium BACKGROUND: The Endophthalmitis Vitrectomy Study (EVS) suggests that vitrectomy is only necessary in cases with poor hand motions vision or worse. When the EVS was published began an ongoing controversy: was the choice of antibiotics appropriate, how extensive was the vitrectomy (biopsy or complete vitrectomy), how relevant are the results to non post endophhtalmitis cases. The last decade has also seen the evolution of vitreoretinal instruments and machines which facilitate the conduct of surgery. Recent literature also suggests that a more aggressive approach to endophthalmitis can lead to significant improvements in vision beyond those obtained in the context of the EVS. METHODOLOGY: Review of the recent literature and own results with and without endoscopy are compared to the results published out of the EVS
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 18
Abstract Book study. RESULTS: For patients with more than count fingers (CF) vision, rapid injection of antibiotics and careful follow-up appears to be sufficient. At CF and below, in the absence of retinal necrosis, considerable vision improvement is possible with an aggressive approach to vitrectomy including posterior hyaloid detachment. In eyes with necrosis extending anteriorly, the use of silicone oil may help preserve ocular integrity. Currently used broad spectrum intravitreal antibiotics appear in all cases to be sufficient. CONCLUSION: A more aggressive surgical approach to patients with CF vision or worse appears better able to provide improvement in vision than suggested by the EVS protocol. It also allows for a better staging of disease severity and is associated with a decreased likelihood of enucleation or evisceration.
P10-7 THE ROLE OF INTRAVITREAL STEROIDS IN THE MANAGEMENT OF ENDOPHTHALMITIS. Pathengay Avinash (Visakhapatnam LV Prasad Eye Institute, India) Introduction: Endophthalimtis is a double-edged sword characterised by infection and inflammation. Results: Corticosteroids are known to limit the degree of inflammation and serve as an adjunct to antibiotics and vitrectomy in the management of infectious bacterial endophthalmtis. Favourable outcome seen after management of endophthalmitis due to coagulase negat ive micrococci is not seen with organisms like Streptococcus spp, Staphylococcus aureus, Pseudomonas spp and Bacillus cereus. This makes one ponder why management with vitrectomy and intravitreal antibiotics does not produce similar results in endophthalmitis due to different organisms. This question can be answered to a certain extent by understanding that organisms like Streptococcus spp, Staphylococcus aureus, Pseudomonas spp and Bacillus cereus liberate potent toxins and tissue damaging enzymes contributing to virulence clinically presenting as a fulminant infection. The inflammation produced by these organisms can be neutralised with corticosteroids. Our experience with intravitreal dexamethasone and triamcinolone in the management of bacterial endophthalmitis will be discussed. Conclusions: Finding the ideal anti-inflammatory Rx and the approporiate timing and administration of this treatment remains an important task in endophthalmitis management. Financial fundings: none Conflict of interest: none Keywords: endophthalmitis
P11A-2 MULTIMODAL MAPPING PRINCIPLES AND USE IN UVEITIS Marc D. de Smet, Division of Vitre o retinal surge ry, Z NA Middelheim Campus, Antwerp, Belgium BACKGROUND: Optical coherence tomography (OCT) provides high resolution cross sectional images of the retina. Surface reconstructions of the
retina, or three dimensional volume maps, provide us with the possibility to accurately map the location of pathologic lesions. Accurate localization allows for temporal comparisons or overlay with other imaging modalities. METHODS: With the OCT/SLO in either spectral domain or time domain mode, we created both surface maps and volume maps to assess a series of retinal and subretinal lesions in patients with uveitis. We have also made careful overlays with standard angiography. These were analyzed for progression in size (surface area or volume), or the correlation of lesions with clinically relevant markers or activity such as fluorescein leakage RESULTS: The use of either surface or volume maps was sufficient to provide a detailed temporal profile of intraocular processes particularly neovascularization and macular edema, and the response to therapy. Overlay with angiograms allows for a more detailed analysis of retinal/choroidal lesions and can be useful in identifying patients with active disease in causes such as sympathetic ophthalmia. CONCLUSION: OCT is a valuable tool in the assessment of patients with active inflammation and in determining the severity and response to treatment.
P11A-5 IMAGING OF MACULAR EDEMA USING THE SLO/OCT van Velthoven Mirjam EJ (Academic Medical Center Amsterdam), de Smet D Marc (Middelheim Hospital Antwerp) Objective: To evaluate the use of the SLO/OCT in the diagnosis and follow up in patients with macular edema, particular in relation to inflammatory eye diseases. Through the years this technique has evolved, both in imaging resolution and in post-acquisition processing. Unique to the system is the confocal fundus image that allows for perfect registration of acquired OCT scans and for overlay with other imaging techniques. Methods and Results: In the past 5 years many patients with a variety of inflammatory diseases and other causes of macular edema have been imaged with the SLO/OCT. A series of cases is presented to illustrate the use of SLO/OCT imaging in case of macular edema. With the SLO/OCT it is easy to distinguish 3 major forms of macular edema: cystoid macular edema, diffuse macular edema and focal (cystoid) edema. Thanks to the confocal fundus imaging a good follow up registra tion is created through direct overlay of the current visit with the previous. In case a slightly different area is imaged, the overall change or lack thereof can still be appreciated. Overlay of fluorescein angiography or microperimetry with both the confocal and the OCT image offers a unique combination of function and structure, which has shown to elucidate both imaging techniques. Conclusion: Imaging of macular edema with the SLO/OCT allows for high resolution, detailed images, but also offers a good registration technique for proper follow up of patients undergoing treatment. Moreover, it allows for the creation of overlay images combining functional and morphological data, which helps to better understand the disease at hand. Financial fundings: None Conflict of interest: None
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Abstract Book Keywords: macular edema, optical coherence tomography
2University of Lausanne, Lausanne, Switzerland.
P11B-2 OPTICAL COHERENT TOMOGRAPHY IN UVEITIS Asyari Fatma (University of Indonesia; AINI Eye Hospital ) PURPOSE. To evaluate the optical coherence tomography (OCT) images of the choroid , retina and retinal substructures in cases of uveitis. METHODS. OCT images were taken from various cases of uveitis RESULTS. Alterations in retinal tissue can be identified easily with OCT imaging such as increased retinal thickness with accumulation of intraretinal fluid (e.g. diabetic retinopathy, cystoid macular oedema, retinal traction evident by the visualization of the posterior hyaloid or an epiretinal membrane exerting traction). Decreased retinal thickness is seen with scarring or atrophy of the retinal tissue. Increased reflectivity is caused by inflammatory infiltrate, fibrosis, exudates and haemorrhage. Highly reflective tissue, like large clumps of exudates and haemorrhage, cause shadowing effects by attenuating further progression of light. Decreased reflectivity is seen in retinal oedema, hypopigmentation of the RPE and as shadowing behind highly reflective regions. Foveal changes: Include presence of a defect as in macular hole, contour alterations such as steepening in ERM , and flattening as in impending macular hole, foveal oedema and vitreoretinal traction. Conclusions. Optical coherence tomography may provide useful information on complications developing in uveitis patient, and clinical applications of OCT is very helpful to detect the details of pathhological changes that occured , such as detached retinal layers, schisis, CSR, PED, edematous, swollen retina , exudate and retinal necrosis in diabetes, uveitis, vein occlusion. "Missing" retina can be seen in macular hole;while “ extra tissue “in epiretinal and choroidal neovascular membrane, as well as the effects of glaucoma to the optic disc . Financial fundings: none Conflict of interest: none Keywords: OCT, uveitis,macula
P11B-3 COMBINED FLUORESCEIN/INDOCYANINE GREEN ANGIOGRAPHIC SCORING SYSTEM FOR UVEITIS Tugal-Tutkun Ilknur ( I s t a n bul Unive rsity Istanbul faculty of Medicine Dept of Ophthalmology) FA and ICGA are essential imaging techniques in the appraisal of posterior segment inflammation. A combined FA/ICG angiographic scoring system is proposed in order to estimate the magnitude of retinal vs choroidal involvement, follow up disease progression, monitor response to treatment, and provide quantitative data for clinical studies.
P11B-5 INFLUENCE OF INDOCYANINE GREEN ANGIOGRAPHY ON OUR APPRAISAL OF CHOROIDITIS Carl P. Herbort1,2 1Inflammatory and Retinal Eye Diseases, Center for Ophthalmic Specialized Care, Lausanne, Switzerland.
Indocyanine green angiography has allowed to reclassify choroidal inflammation according to the structure that is preponderantly or initially involved. At the present stage of our knowledge there seem to be at least two main mechanisms of inflammation touching the choroid. Primary inflammatory choriocapillaropathy (PICCP) This first group of diseases, formerly mostly included in the inadequate term of “white dot syndromes” results from inflammation at the level of the choriocapillaris causing areas of choriocapillaris non perfusion and its ischaemic consequences both at the level of the choroid but also at the level of the outer retina that depends on the choriocapillaris for oxygen and nutrients. Acute posterior multifocal placoid pigmentary epitheliopathy (APMPPE) is a disease typically illustrating this type of choroidal inflammation. Stromal choroiditis In the second group of diseases, the primary mechanism is the development of inflammatory foci, mostly granulomatous at the level of the stroma appearing hypofluorescent on ICGA, usually associated with inflammation of larger non-fenestrated stromal vessels appearing on ICGA as fuzzy vessels in the intermediate phase fo l l owed by diffuse late choroidal hyperfluorescence. Vog t Koyanagi-Harada disease or birdshot chorioretinopathy are typical illustrations of this type of choroidal inflammation. Although the mechanism is completely different from the first type of diseases, these conditions have also been included by some authors in the “white dot syndromes”. Secondary inflammatory choriocapillaropathy As usual in inflammatory disorders, the inflammation is not strictly limited to the primary site of involvement but can also touch adjacent stru c t u res. For example seve re retinitis caused by Toxoplasma Gondii usually extends to the choriocapillaris causing secondary inflammatory choriocapillaropathy. Likewise severe stromal disease can cause inflammation at the level of the choriocapillaris and beyond to the retinal pigmentary epithelium and to the retina as in Vogt Koyanagi Harada disease. Summary : classification of choroiditis Two main lesional mechanisms determine the classification of choroiditis : 1. Choriocapillaris inflammation (primary inflammatory choriocapillaropathies) - MEWDS / AIBSE - APMPPE - Multifocal choroiditis / PIC - Serpiginous choroiditis - Rare entities : AMN, AZOOR 2. Stromal inflammation (stromal choroiditis) further subdivided into 2 categories 2.1. Primary obligatory stromal choroiditiis - Vogt-Koyanagi-Harada disease - Sympathetic Ophthalm - Birdshot choriortinopathy 2.2. Stromal choroiditis as a random location of a systemic disease - Sarcoidosis - Tuberculosis
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 20
Abstract Book - Syphilis
P12-1 AUTOIMMUNE REGULATION IN ANGIOGENESIS: AN OVERVIEW Gardner Thomas W. (Penn State University College of Medicine ) Objectives: To summarize known the relationships between retinal angiogenesis and autoimmune regulation in diabetic retinopathy and macular degeneration. Methods: Data from published studies. Results: Ocular and systemic cellular responses and inflammatory factors that promote angiogenesis will be discussed. Conclusions: Ocular angiogenesis is a complex ocular and systemic response to cellular stresses. Financial fundings: Juvenile Diabetes Research Foundation Conflict of interest: None TG is a consultant for Fove a Pharmaceuticals, Oxigene, QLT Key wo rd s : D i abetic re t i n o p at hy, macular dege n e rat i o n , angiogenesis
P12-2 IS DIABETIC RETINOPATHY AN INFLAMMATORY DISEASE? Adamis Anthony P. (Jerini Ophthalmic) Inflammation has been linked to some of the earliest changes of experimental diabetic retinopathy. New data show that chronic, low-grade subclinical inflammation is responsible for many of the signature vascular lesions of diabetic retinopathy. Mice deficient in the genes encoding for the inflammatory cell recruitment (ICAM-1 and CD18) demonstrate a marked and sustained suppression of endothelial cell injury, blood-retinal barrier breakdown, pericyte loss and acellular capillary formation. Taken together, these data indicate that diabetic retinopathy is an inflammatory disease, with CD18 and ICAM-1 representing specific therapeutic targets. Financial fundings: (None.) Conflict of interest: Jerini Ophthalmics Keywords: INFLAMMATION, DIABETIC, RETINOPATHY
P12-6 AUTOIMMUNE RETINOPATHY: A REVIEW AND SUMMARY John R. Heckenlively, M.D. Paul R. Lichter Professor of Ophthalmic Genetics Director, Visual Physiology Laboratory Kellogg Eye Center University of Michigan, Ann Arbor, MI 48105 USA Autoimmune retinopathy (AIR) currently is among the more difficult ophthalmic diagnoses to establish as there are few definitive tests, and a combination of diagnostic factors have to be ascertained in order to have confidence that the diagnosis is correct. Complicating the issue is that AIR can be a secondary complication of other conditions such as carcinomas, retinitis pigmentosa, ocular trauma, birdshot retinopathy, AZOOR, or MEWDS. Primary cases of AIR likely occur, but there is no clear way to identify them clinically.
AIR typically occurs without signs of inflammation (cell or flare) in the front or back of the eye, and signs of uveitis are not a usual feature in the disorder. A caveat is that a few patients with chronic intermittent uveitis have been found to develop AIR later in their disease process. Disorders in which autoimmune anti-retinal antibodies play a pathologic role are: 1. Cancer-associated retinopathy 2. Melanoma-associated retinopathy 3. Autoimmune retinopathy 4. Cystoid edema in retinitis pigmentosa; 5. Panretinal degenerations without pigment deposits that show fast progression 6. Many cases of AZOOR, MEWDS, blindspot syndrome, birdshot retinopathy Establishing the diagnosis The main diagnostic fe at u res associated with autoimmune retinopathy are: 1. Panretinal degeneration with no or little pigment deposition 2. Fast progression by history or visual field 3. Severe electroretinographic changes. Negative waveforms are common. In earlier cases. more severe ERG changes in face of relatively normal retinas or visual field size give weight to the AIR diagnosis. 4. History of autoimmune disease in the family and/or patient. 5. Multiple bands of anti-retinal antibody activity on Western blot. 6. Improvement of visual function on trial of immunosuppression. 7. CAR or MAR, by associative history of the neoplasms. 8. Cystoid macula changes in retinitis pigmentosa patients; may present as edema or macula schisis. Western blots of the patients’ serum against normal retinal protein extracts will typically show anti-retinal IgG and sometimes IgM bands of activity. Demonstrated activity against recoverin is pathognomic for AIR, and when antibodies against ·-enolase, arrestin, carbonic anhydrase, and PNR, the diagnosis is strongly supported if other features are present. Most active cases have a minimum of three different anti-retinal antibodies on Western blot. It should be noted that just having random anti-retinal antibodies does not mean that AIR is present, but when multiple clear bands are present, it lends support to making the diagnosis, and is an indication of an active autoimmune status of the patient. Table 1. PROTEINS WHICH HAVE BEEN ASSOCIATED WITH AUTOIMMUNE RETINOPATHY1,12, 13,14 Name Weight Recoverin Carbonic anhydrase Transducin ·-enolase Arrestin TULP1 PNR photoreceptor cellspecific nuclear receptor Heat shock protein HSC 70
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 21
23 kD 30 kD 35 kD 46 kD 48 kD 78 kD 41 kD 65 kD
Abstract Book
The definitive test for MAR syndrome is to test the patient’s serum (IgG) by indirect immunofluorescent histology to see if there is reactivity against normal donor retina bipolar cells. Some of these patients also have Western blot activity against soluble retinal proteins, and several have shown anti-PNR reactivity. Many patients with positive western blots will also light up specific cell types on indirect immunohistology examinations of normal retina, but it is not yet know how well this corre l ates with pat h ogenecity. Cytotoxic studies have been done which suggest toxicity by various antiretinal antibodies.(Shiraga, 2002; Adamus, 1998.) Treatment of AIR Once a diagnosis of AIR (CAR, MAR) is made, a diagnostic treatment plan should be devised. Many ophthalmologists work in collaboration with rheumatologists because of their familiarity in working with immunosuppressives. In some patients in which the diagnosis is suspected, a treatment trial to one eye with subtenons depomedrol (40-80mg) may be tried. Normally it takes two injections over an 8 to 12 week period, and testing with a kinetic visual field or ERG can be used to measure changes against a baseline. Likewise with systemic immunosuppression, visual fields and occasionally standardized ERG testing can be used to measure treatment effects. It is important to remember that there are seldom quick fixes with these diseases, and it takes CHRONIC immunosuppression to stabilize and regain what retinal function is left. Typically patients on immunosuppression need at least four months to show improvements on visual field testing, and a treatment course may be for a year or more. Indicators for tapering treatment (or leaving patients on a maintenance doses) may be reaching an improved and steady level of function, with disappearance of bands on the Western Blot. Patients with macula edema can be followed clinically, with fluorescein angiography, and OCT testing. Some patients have macular cysts from a schisis-like process, and the OCT is best for following their progress. Au t o i m mune retinopathy is a complex disorder, and often does not p resent in a fixed pat t e rn because different combinations of anti-re t inal antibodies are present from patient to patient, and the various combinations of antibodies result in vari ations in pat t e rns of disease. Other factors such as blood-retinal barrier integrity, and family history of autoimmune diseases can influence the severity. Because circulating a n t i - retinal antibodies are present in patients with many retinal diseases, the challenge is to determine wh i ch ones are pat h ogenic and wh i ch anti-retinal antibodies are benign, and wh at other factors are p resent that cause anti-retinal antibodies to become pathologic? References . Shiraga S, Adamus G. Mechanism of CAR syndrome: antirecoverin antibodies are the inducers of retinal cell apoptotic death via the caspase 9- and caspase 3-dependent pathway. J. Neuroimmunol. 2002;132:72-82. 2. Adamus G, Amundson D, Seigel GM, Machnicki M. AntiEnolase-· Autoantibodies in Cancer- A s s o c i ated Retinopat h hy : Epitope Mapping and Cytotosicity on Retinal Cells. J. Autoimmunity 1998; 11:671-77. 3 . Chan JW. Paraneoplastic retinopathies and optic neuropathies. Survey of Ophthalmology 48:12-38, 2003. 4. Hooks JJ, Tso MOM, Detrick B. Retinopathies Associated with Antiretinal antibodies. Clincal and Diagnostic Laborat o ry Immunology 2001; 8:853-858. 5. Heckenlively, Fawzi AA, Oversier J, Jordan BL, Aptsiauri N. Autoimmune Retinopathy; Patients with antirecoverin immunorea c t ivity and panretinal dege n e ration. A rch. Ophthal. 2000;118:1525-1533.
6. Heckenlively JR, Aptsiauri N, Nusinowitz S, Peng,C, Hargrave P. Investigations of antiretinal antibodies in pigmentary retinopathy and other retinal degenerations. Transactions of the American Ophthalmological Society. Vol. XCIV:179-206, 1996. 7. Heckenlively J, Jordan B, Aptsiauri N. An association of antiretinal antibodies and cystoid macular edema in retinitis pigmentosa patients. American Journal of Ophthalmology. 127:565-578, 1999. 8. Heck enlively JR, Aptsiauri N, Holder GE. Autoimmune retinopathy, in: Heckenlively JR and Arden GB. Principles and Practice of Clinical Electrophysiology of Vision, MIT Press, 2006. 9. Cross S, Salomao DR, Parisi JE, Kryzer TJ, Bradley EA, Mines JA, Lam BL, Lennon VA. Ann Neurol 2003;54:38-50. 10. Thirkill CE, FitzGerald P, Sergott RC, Roth Am, Tyler NK, Keltner JL. Cancer-associated retinopathy (CAR syndrome) with antibodies reacting with retinal, optic nerve, and cancer cells. N Engl J Med. 1989:321:1589-94. 1. Jankowska R, Witkowska D, Por´bska I, Kuropatwa M, Kurowska E. Gorczyca WA. Serum antibodies to retinal antigens in lung cancer and sarcoidosis. Pathobiology 2004; 71:323-328. 2. Adamus G, Ren G, Weleber RG. Autoantibodies against retinal proteins in paraneoplastic and autoimmune retinopathy. 3. Ohguro H, Ogawa KI, Maeda T, Maeda A, Maruyama I. Cancer-associated retinopathy induced by both anti-recoverin and Anti-hsc70 antibodies in vivo. Invest. Ophthalmol Vis Sci. 1999;40:3160-3167. 4. Potter MJ, Adamus G, Szabo SM, Lee R, Moshaseb K, Behn D. Autoantibodies to transducin in a patient with melanoma-associcated retinopathy. Am. J. Ophthalmol. 2002;134:128-130. 5. Alexander KR, Fishman GA, Peachey NS, Marchese AL, Tso MO: “On” response defect in paraneoplastic night blindness with cutaneous malignant melanoma. Invest Ophthalmol Vis Sci 1992; 33: 477-483. 6. Lei B, Bush RA, Milam AH, Sieving PA: Human melanomaassociated retinopathy (MAR) antibodies alter the retinal ONresponse of the monkey ERG in vivo. Invest Ophthalmol Vis Sci 2000; 41: 262-266. 7. Milam AH, Saari JC, Jacobson SG, Lubinski WP, Feun LG, Alexander KR: Autoantibodies against retinal bipolar cells in cutaneous melanoma-associated retinopathy. Invest Ophthalmol Vis Sci 1993; 34: 91-100. 8. Gittinger JW Jr, Smith TW: Cutaneous melanoma-associated paraneoplastic retinopathy: histopathologic observations. Am J Ophthalmol 1999; 127:612-614. 9. Jacobson DM, Adamus G. Retinal anti-biolar cell antibodies in a patient with paraneoplastic retinopathy and colon carcknoma. Am. J. Ophthalmol. 2001;131:806-808. 20. . Pfohler C, Haus A, Palmowski A, Ugurel S, Ruprecht KW, Thirkill CE, Tilgen W, Reinhold U. Melanoma-associated retinopat hy : high frequency of subclinical findings in patients with melanoma. Br J Dermatol 2003; 149: 74-78. 21. Keltner JL, Thirkill CE, Yip PT. Clinical and Immunologic Characteristics of Melanoma-Associated Retinopathny Syndrome: eleven new cases and a review of 51 previously published cases. 22. Kellner U, Bornfeld N, Foerster MH: Severe course of cutaneous melanoma associated paraneoplastic retinopat hy. Br J Ophthalmol 1995; 79: 746-752. 23. Kiratli H, Th i rkill CE, B i l gic S, Eldem B, Kececi A. Paraneoplastic retinopathy associated with metastatic cutaneous melanoma of unknown primary site. Eye 1997; 11: 889-892.
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Abstract Book
P13-2 EVALUATION OF LIMBAL STEM CELL DEFICIENCY Harminder S Dua Corneal epithelial stem cell deficiency (SCD) can result in a number of pathological changes ranging from metaplastic epithelium on the cornea to complete corneal breakdown. Evaluation of SCD has three important facets: 1) Evaluation of the Diagnosis. 2) Evaluation of the Extent and 3) Evaluation of the Patient. The diagnosis of SCD is essentially clinical and demonstration of goblet cells in corneal epithelium by impression cytology, biopsy or confocal microscopy can be confirmatory. Integral to this evaluation is the determination of any ongoing inflammation. The extent of SCD is usually classed as unilateral or bilateral and partial (visual axis affected or spared) or total. The examination of the rest of the eye includes assessment of the thickness and clarity of the corneal stroma underlying the fibrovascular pannus, the intraocular pressure, the visual potential by electrophysiological tests, eyelids and tear function, workup of the patient for imunosuppession and HLA typing of the patient and potential living related donors. Management protocols are determined by the above evaluation. For Partial SCD where the visual axis is involved, Sequential Sector Conjunctival Epitheliectomy is indicated. For Total unilateral cases auto limbal transplantation is the treatment of choice and for Total bilateral cases allo-limbal, cadaver or living related donor transplants are indicated. Amniotic membrane as a patch or graft and exvivo expanded cell sheets can also be used.
P13-3 ROLE OF EMMPRIN (CD147), AN INDUCER OF MATRIX METALLOPROT E I NASES SYNTHESIS DURING CORNEAL REMODELLING Gabison Eric E (Fondation Rothschild, Hopital Bichat, APHP, Paris, France), Huet Eric (CNRS UMR 7149), Menashi Suzanne (CNRS UMR 7149) Introduction and objectives: EMMPRIN is a cell surface glycoprotein enriched on tumor cells and normal epithelia. We previously demonstrated its ability to induce MMPs production in fibroblasts following direct epithelial-stromal interaction in corneal ulcerations. We sought to examine whether EMMPRIN has a broader role promoting fibroblasts to myofibroblasts differentiation. Methods: Since aSMA is considered a marker of this differentiation process, we analysed the effect of EMMPRIN on its expression in corneal and skin fibroblasts by western blots, immunocytochemistry and by a functional assay of collagen lattice contraction. Results: Increasing EMMPRIN expression by cDNA transfection or by treatment with exogenously added recombinant EMMPRIN resulted in an upregulation of aSMA expression. EMMPRIN also increased the contractile properties of the treated fibroblasts as demonstrated by the immunohistochemical appearance of stress fibres and by the accelerated contraction of fibroblasts embedded collagen lattices. Blocking EMMPRIN expression by siRNA inhibited aSMA and collagen gel contraction induced not only by EMMPRIN but also by TGFb, a major mediator of myofibroblast differentiation that also regulated EMMPRIN expression. Conclusions:These findings, and the fact that EMMPRIN and aSMA colocalised to the same cells in the stroma of pathological corneas, expand on the mechanism by which EMMPRIN remodels extracellular matrix during wound healing.
Financial fundings: Fondation de l'Avenir, Association des Gueules cassées. Conflict of interest: no conflict or interest Keywords: cornea, wound healing, ulceration
P13-4 NEW IMAGING TECHNIQUES FOR ASSESSING OCULAR SURFACE INFLAMMATION Labbé Antoine The ocular surface constitutes a complex physiopathological and anatomical entity assuring the barrier between the outside world and the fragile ocular structures. The immunologic status of the ocular surface is often difficult to assess accurately: clinical signs are sometimes unreliable and ophthalmic instruments such as the slit lamp, which magnifies approximately 40 times, cannot provide details of the corneal and conjunctival structures at the cellular level. In vivo confocal microscopy using the HRT II Rostock Cornea module® (HRT II / RCM) provides better resolution and t h e re fo re outlines distinctively in vivo infl a m m at o ry ch a n ge s occurring in the ocular surface. In vivo confocal microscopy is capable of providing corneal, conjunctival and limbal cellular details in different ocular surface inflammatory disorders such as such as vernal keratoconjunctivitis, toxic keratitis, Thygeson’s keratitis or corneal neovascularization. In correlation with ex vivo impression cytology analysis, it thus constitutes an interesting aid in the diagnosis and management of complex ocular surface inflammatory conditions. Financial fundings: (None.) Conflict of interest: (None.) Keywords: In vivo confocal microscopy, ocular surface, inflammation
P13-5 INTEREST ON LIPIDS IN OCULAR SURFACE DISORDERS Creuzot Catherine (Department of Ophthalmology - CHU Dijon France), Souchier Maxime (Department of Ophthalmology - CHU Dijon France), Viau Sabrina (Eye and Nutrition Unit - INRA Dijon), Joffre Corinne (Eye and Nutrition Unit - INRA Dijon), Brétillon Lionel (Eye and Nutrition Unit - INRA Dijon), Bron Alain (Department of Ophthalmology - CHU Dijon France) Tears represent the interface between the eye and the outer environment. Tears are composed of a water-mucus gradient covered at the outer face by a thin layer of lipids. The main functions of this tear lipid layer are to lubricate facilitating the movement of the eyelids during blinking, to prevent the evaporation of the aqueous tear fluid, to protect against the entry of micro organisms and organic matter and to enhance the stability of the tear film. The lipid layer is mainly composed of meibomian lipids and consists in superficial non polar hydrophobic lipids (wax and cholesterol esters) linked with hydrophobic bonds, with a polar phase (phospholipids). Changes in the lipid profile as well as protein content of meibomian secretion can result in tear film instability. The main ocular surface disorder associated with these changes is blepharitis. Posterior chronic blepharitis is associated with meibomian gland dysfunction leading to abnormal lipid secretion. Tear fatty acids are normal in healthy individuals and in dry eye patients but they are different in
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 23
Abstract Book blepharitis patients: the main significant difference is an increase in branched-chain fatty acids and a decrease in palmitic (C16) and stearic (C18) acids in blepharitis patient tears. Branched-chain fatty acids are not toxic on Chang cells. Such results suggest that the change observed in tear fatty acid composition in blepharitis seems to be a consequence rather than a cause of the corneo-conjunctival cell anomalies observed in patients suffering from blepharitis. The impact of anti-inflammatory treatment on lipids remains to be determined. Financial fundings: INRA Conflict of interest: (None.) Keywords: Lipids:dry eye: blepharitis
P14-3 CURRENT UPDATE: PREVENTION AND MANAGEMENT OF CORNEAL GRAFT REJECTION U Pleyer, S Stanojlovic, T Ritter Department of Ophthalmology, Charité, Humboldt University, Berlin, Germany Corneal transplantation has definitely its paradoxes. It is both, the most successful as well as probably the most underestimated procedure regarding its risks in clinical transplantation. Indeed, the common assumption, that corneal transplantation is a safe procedure with good prognosis may have hindered more intensive efforts of research in this field. Interestingly it seems the rejection rate has not changed in the last 30 years. Therefore more efficient preventive and therapeutic efforts are required to improve the prognosis after keratoplasty. In recent years the use of experimental keratoplasty models in rodents has broadened not only our understanding of the immunobiology of corneal grafts, but also led to new preventive and therapeutic options. We therefore like to focus the attention first to the underlying immune mechanisms before we approach current and new treatment possibilities. Currently, several options are used to reduce the risk of corneal allograft rejection. Most are derived from other fields of transplantation medicine including MHC histocompatibility matching and pharmacological immune modulation. An update of preventive and therapeutic options as well as future developments will be presented. Supported in part by Deutsche Forschungsgemeinschaft DFG (PL 150/14-1 and Ri 764/10-1) and Charité grant
ex p ression of the therapeutic gene provides new and exciting prospects wh i ch may result in a better bioava i l ability of the immunomodulat o ry agent and wh i ch may reduce or avoid systemic immunosuppression. In contrast to other tissues that are ro u t i n e ly transplanted, the cornea can be cultured for a pro l o n ged period of time and there fo re allows efficient ex - v ivo manipulation. F u rt h e rm o re, the cornea is easily accessible and its perfect tra n spare n cy allows direct visual observation of inflammat o ryprocesses. Along with different viral and non-viral vector systems, mammalian cells have also been considered as vehicles for delivery of therapeutics. The major advantage of cell-based delivery approach is based on the fact that the virus is not delivered directly into the recipient’s tissue, instead the therapeutic cells are manipulated ex vivo before being given to the recipient. Donor derived dendritic cells (DCs) and regulatory T cells (Tregs) seem to be the most promising cellular targets for gene therapy. In this presentation novel therapeutic strategies using either recombinant viruses as gene transfer vehicle or gene-modified dendritic cells or regulatory T cells to protect the graft from immune-mediated rejection will be discussed. Financial fundings: Supported by Deutsche Forschungsgemeinschaft (DFG, PL 150/14-1 and Ri 764/10-1) and Science Foundation of Ireland (SFI, 06/RFP/BIC056) Conflict of interest: None Keywords: Transplantation, Immunomodulation, Gene Therapy
P15-2 INTRAVITREAL TRIAMCINOLONE FOR UVEITIS AND ITS COMPLICATIONS Russell W. Read, MD Associate Professor of Ophthalmology and Pathology University of Alabama at Birmingham Intraocular injections of corticosteroids, primarily triamcinolone acetonide, have rapidly come into widespread use for a variety of ocular indications, including uveitis and its complications. Multiple case series and anecdotal reports have been published regarding the use of intraocular corticosteroid in uveitis, but no large scale, randomized trials are availaible. Issues that must be considered in deciding on whether to use intravitreal corticosteroids include the potency, kinetics, onset and duration of anti-inflammatory effect, as well as the side effect profile.
P14-4 NOVEL THERAPEUTIC STRATEGIES TO PREVENT CORNEAL ALLOGRAFT REJECTION Ritter Thomas (The Regenerative Medicine Institute, National University of Ireland, Galway) With more than 60.000 procedures a year, penetrating keratoplasty is the most frequent tra n s p l a n t ation pro c e d u re of human tissue. Te chnical advances in microsurgery have played a key role in improving the quality of keratoplastic results. However, long term graft survival is limited by immu n o l ogical pro blems. Continued preventive and therapeutic effo rts are re q u i red to improve the prognosis after keratoplasty. Less toxic tre atment protocols need to be introduced into the transplant setting to prevent the rejection of allogeneic grafts. The genetic modifi c ation of the graft or cells prior to transplantation is an at t ractive ap p ro a ch to protect the graft from allogeneic re j e ction. The transplant setting offe rs the unique advantage for ge n e t h e rapy to modify allografts ex - v ivo prior to transplantation. Local
P15-7 INTRAOCULAR INJECTION OF STEROIDS FOR SCLERITIS Arellanes Lourdes, Navarro Patricia (Asociación Para Evitar la Ceguera en México) Introduction and objectives. To present a series of anterior scleritis patients treated with a single injection of intravitreal triamcinolone. Method: Longitudinal, prospective, interventional study of a series of cases. Results: Three patients, 2 were female, age: 49 to 65 years.Two patientes had Wegener`s granulomatosis and one Rheumatoid Arthritis, systemic disease was inactive in all cases. Patients presented with an unilateral, diffuse anterior scleritis, unresponssive to systemic corticotherapy associated to other immunosuppressors. They agreed to be treated with a single intravitreal injection of tri-
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Abstract Book amcinolone acetonide. No complications were observed. Two patientes have been follow for 21 months and one for two years. No recurrence of inflammation has been noticed. Conclusions: Our results suggest that in selected patients unresponssive to systemic therapy, or with severe side effects due to treatment, or in those who refuse more agressive immunosuppresion, an intravitreal triamcinolone injection may be a helpful adjunctive therapy. A larger series of cases is needed to prove this statment. Financial fundings: None Conflict of interest: None Key wo rd s : Corticosteroids, intravitreal injection, refractory scleritis.
P15-8 INTRAVITREAL TREATMENT OF INFECTIOUS RETINITIS Arevalo J. Fernando (Clinica Oftalmologica Centro Caracas ) Introduction and objectives: To describe the use of high doses of intrav i t real ga n c i cl ovir for the treatment of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) therapy. Methods: Twenty-eight HIV-infected patients (38 eyes) and active CMV retinitis (84.2% in zone 1 and 36.8% resistant) were treated with high dose intravitreal ganciclovir (5.0 mg once a week) in combination with HAART therapy. Intravitreal injections were discontinued once CMV retinitis healed. Mean follow-up was 24 months. Results: Complete regression of the retinitis was obtained with high doses of intravitreal ganciclovir in 84.2% of eyes (3 patients died before the conclusion of the study) at a mean of 4.8 weeks. Visual acuity improved 2 or more lines in 58.8% of eyes. No ganciclovir retinal toxicity was identified. The mean CD4+ T-cell count increased from 104.8 to 280.8 cells/μL. Six eyes presented CMV retinitis reactivation at a mean of 25.6 days after their last injection. Complications (4%) included immune recovery uveitis (4 eyes), retinal detachment (2 eyes), and endophthalmitis (1 eye). Conclusions: High doses of intravitreal ganciclovir (5.0 mg) in combination with HAART therapy can be well tolerated. Intravitreal ganciclovir may be discontinued after CMV retinitis has healed. Financial fundings: The Arevalo-Coutinho Fo u n d ation for Research in Ophthalmology, Caracas, Venezuela Conflict of interest: None Keywords: CMV retinitis, High dose, Intravitreal ganciclovir
P17-3 LOCAL IMMUNOMODULATION OF OCULAR INFLAMMATION AND MACROPHAGE/MICROGLIA POLARIZATION de Kozak Yvonne (UMRS 872 Eq 17 CRC), Camelo Serge (UMRS 872 Eq 17 CRC), Omri Boubaker (UMRS 872 Eq 17 CRC), Nardin A l e s s a n d ra (UMRS 872 IDM CRC), B e h a r-Cohen Fra n c i n e (UMRS 872 Eq 17 CRC), Crisanti-Lassiaz Patricia (UMRS 872 Eq 17 CRC) Introduction and objectives: The eye is considered as an immuneprivileged site through its environment and presence of cells and
molecules that suppress infl a m m atory responses. Macrophage/microglial phenotype and function (M1 and M2) are regulated by CNS-resident cells and their products. We will show here the efficiency of intraocular injection of immunomodulatory molecules: interleukin-13 (IL-13), monocyte activator muramyl tripeptide-PE loaded in liposomes (L-MTP-PE) on endotoxininduced uveitis. Methods: These molecules were administered into the eye simultaneously or 7 days before subcutaneous injection of LPS in Lewis rats. Clinical and histopathological observations were performed. Cytokine and chemokine mRNA expression was detected in the eyes by RT-PCR. Results: We show that macrophages remain resistant to apoptosis, showing either an effector phenotype with TNF-a and nitrite production in saline-injected controls or an alternatively activated phenotype with low TNF-a and NO, and high TGF-b as a result of IL13 treatment. Importantly, treatment decreased atypical PKCzeta cleavage, nuclear NF-kappaB/p65 and increased NF-kappaB/p50, BCL3, TGF-b2 and reduced caspase 3 expression promoting m a c ro p h age surv ival. Tre atment accelerated EIU resolution through premature apoptosis of neutrophils related to high expression of TLR4 and activated caspase 3. The role of macrophages d u ring ocular infl a m m ation was further demonstrated by the inhibitory effect on EIU of intraocular injection of L-MTP-PE. Indeed the treatment reduced intraocular infiltration of PMNs and increased the number of resident microglia in retina and macrophages in iris/ciliary body with CD200R expression. A reduction of ocular inflammatory cytokines, chemokines and NOS2 was observed with increased expression of TGF-b. Conclusions: It is suggested that treatments protected ocular tissues, led to apoptosis of PMNs and polarization of alternatively activated macrophages (M2) in the contact of regulatory molecules present in the eye with resultant decrease of inflammation. Financial fundings: This work was supported by grants from INSERM (Institut National de la Santé et de la Rech e rche Médicale) and MENRT (Ministère de l'Education Nationale, de la Recherche et de la Technologie)(Laure Lajavardi). Serge Camelo is recipient of an ANR (Agence Nationale pour la Recherche) PNRV (Programme National de Recherche sur la Vision) grant and a BQR grant from Université René Descartes, Paris 5. C o n flict of interest: The authors have no financial conflict of intere s t Keywords: Uveoretinitis, Vaso intestinal peptide, Intraocular drug delivery
P17-4 INTRAOCULAR ADMINISTRATION OF VASOACTIVE I N T E S T I NAL PEPTIDE- LOADED LIPOSOMES PROTECTS AGAINST EXPERIMENTAL AUTOIMMUNE UVEORETINITIS BY REGULATION OF LOCAL AND SYSTEMIC IMMUNE RESPONSES. Camelo Serge1, Lajavardi Laure 2, Bochot Amelie 2, Fatal Elias 2, Thillaye-Goldenberg Brigitte1, Naud Marie-Christine1, BeharCohen Francine 1 and de Kozak Yvonne1 1Centre de Recherche des Cordeliers, Université Pierre et Marie Curie - Paris6, UMR S 872, Paris, F-75006 France ; Université Paris Descartes, UMR S 872, Paris, F-75006 France ; INSERM, UMR S 872, Paris, F-75006 France. 2UMR 8612. CNRS, Unive rsité Pa ris-Sud; Physico-chimie Pharmacotechnie – Biopharmacie. Faculté de Pharmacie. 5 rue JB Clément. 92296 Châtenay-Malabry Cedex. France.
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Abstract Book Introduction and objectives: Local delivery of therapeutic molecules is a promising method to treat uveitis while limiting severe systemic side effects observed in patient treated by systemic injection of high doses of immuno-modulators. Our goal was to reestablish the immunosuppressive microenvironment of the eye disrupted during experimental autoimmune uveoretinitis (EAU) by one intravitreal injection (IVT) of Vasoactive Intestinal Peptide (VIP) an immunosuppressive neuropeptide encapsulated in liposomes to augment its stability in ocular media. Methods: EAU was induced in male Lewis rats by immunization with S-Ag in CFA. Therapeutic efficacy of a single IVT injection of rhodamine-labeled liposomes loaded with VIP (VIP-Rh-Lip) vs. IVT injection of saline, VIP or empty Rh-Lip was determined by clinical slit lamp examination. Retinal tissue destruction was assessed by histological examination. Inflammatory cells infiltration, macrophages activation and biodistribution of VIP-Rh-Lip were determined by immuno-histochemistry. Intraocular and systemic cytokine production was determined by multiplex ELISA assay. Delayed type hypersensitivity responses as well as inguinal LN T cell proliferation were determined. Results: IVT injection of VIP-Rh-Lip decreased EAU clinical score and protected retinal tissues. Reduction of EAU severity in treated rats was accompanied by decreased intraocular infl a m m at o ry cytokines including IL-17 and NO production. In vivo and in vitro T cell reactivity to S-Ag was reduced in VIP-Rh-Lip treated rats. Concomitantly, IL-10 concentration in supernatants of inguinal LN cells of treated rats was increased. VIP-Rh-Lip injected IVT were phagocytosed mainly by macrophages in the posterior segment of the eye. Conclusion: A single IVT injection of VIP-Rh-Lip reduces EAU severity and protects ocular tissues. The local delivery of the fragile neuropeptide VIP encapsulated within liposomes allows its slow release in ocular tissues and LN and modulates the immune response locally and systematically. Thus, intraocular injection of VIP loaded liposomes is an effective therapeutic strategy to protect ocular tissues during uveitis. Financial fundings: This wo rk was supported by grants from INSERM (Institut National de la Santé et de la Recherche Médicale) and MENRT (Ministère de l'Education Nationale, de la Recherche et de la Technologie)(Laure Lajavardi). Serge Camelo is recipient of an ANR (Agence Nationale pour la Recherche) PNRV (Programme National de Recherche sur la Vision) grant and a BQR grant from Université René Descartes, Paris 5. C o n flict of intere s t : The authors have no financial conflict of intere s t Keywords: Uveoretinitis, Vaso intestinal peptide, Intraocular drug delivery
P17-5 SPECIFIC AND SUSTAINED CONTROL OF TGF EXPRESSION WITHIN THE EYE Amélie Bochot1, Elias Fattal1, Ana L. Gomes dos Santos1,2, Aoife Doyle3, Yvonne de Kozak3, Francine Behar-Cohen3 1Université Paris-Sud 11, School of Pharmacy, UMR CNRS 8612, 5 Rue Jean-Baptiste Clément, 92296 Châtenay-Malabry, France. 2Departamento de Ciencias Farmaceuticas, Centro de Ciencias da Saude, Unive rsidade Fe d e ral de Santa Catarina (UFSC), Florianopolis, SC (Brazil). 3French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale, INSERM) U598, Paris, France.
P u rp o s e : To characterize antisense T G F ? ? - o l i go nucleotide (ODN)/Polyethylenimine (PEI) complex preparation for potential transfection of retinal cells and to design microspheres combining sustained delivery and enhanced intracellular penetration for local administration of ODN. Method: The effect of medium preparation was evaluated on particle size and morphology. Cultured Lewis rat RMG cells were transfected using FITC-ODN/PEI complexes specifically directed at TGF‚-2. Transfection efficacy was evaluated using confocal microscopy and regulation of gene expression was assayed using quantitative real time RT-PCR and Elisa assay. One, 24 and 72 hours after injection of FITC-ODN/PEI complexes in the vitreous of rat ey es, their distribution was analyzed on eye sections. Nanosized complexes of ODN/PEI and naked ODN were encapsulated into poly(lactide-co-glycolide) microspheres. The efficiency of microspheres encapsulating complexes to modulate the healing process after filtration surgery on a rabbit model was also investigated. Result: Complexes prepared in HBS were smaller than complexes prepared in pure water and presented a core-shell structure. These particles showed a high cellular internalization efficacy, along with a significant and specific down regulation of TGF‚-2 expression and production in RMG cells, correlating with specific inhibition of cell growth at 72 hours. In vivo, complexes efficiently transfect retinal cells and follow a transretinal migration at 24 hours. After 72 hours ODN seems to preferentially target RMG cells without inducing any detectable toxicity. A marked influence of microsphere composition on porosity, size distribution and ODN/PEI encapsulation efficiency was observed. Finally, microspheres containing ODN/PEI nanosized complexes were shown to significantly improve bleb survival in a rabbit experimental model of filtering surgery. Conclusion: Specific down-regulation of TGF‚-2 expression using ODN/PEI complexes may have potential interest for the treatment of retinal diseases associated with glial proliferation. Sustained release of nanosized complexes of PEI and antisense TGF-‚2 ODN improves the outcome of glaucoma surgery. Key-words: sustained release, antisense TGF-‚2oligonucleotide, nanosized complexes.
P17-6 CILIARY MUSCLE ELECTROTRANSFER ALLOWS FOR CONTROLLED AND SUSTAINED PRODUCTION OF THERAPEUTIC PROTEINS IN OCULAR MEDIA D ; BenEzra1, Touchard E 1, Bloquel C1, Bigey P 2, Gandolphe C 1,2, , Scherman D 2, Behar-Cohen F 1,3,4 1 INSERM U598 Physiopathology of ocular diseases: Therapeutic innovat i o n s , Paris ; 2 INSERM U640, Pa ri s , 3 Rothschild Ophthalmologic Foundation, 4 Hotel-Dieu of Paris Department of Ophthalmology. Purpose: Our aim was to define the optimal conditions for plasmid transfection into the ciliary muscle in order to achieve a the sustained and controlled secretion of therapeutic porteins in the vitreous cavity. Material and methods: 8-10 weeks old Lewis rats were used in these experiments. Injections of 10μl to 30μl (containing 10 to 30μg) of PVAX2-gLuc (gaussian secreted luciferaes) or pVAX1LacZ plasmids (driven by a CMV promoter) were performed in the ciliary muscle of the rat eye. Several parameters were evaluated regarding the variability and efficacy of transfection and the
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Abstract Book amount of secreted protein: route of injection (corneal tunnel or transscleral), formulation of DNA plasmids, number of injection sites, amount and volume of injected plasmids, electrode shape and electrical parameters. A kinetic of expression was performed with the gLuc encoding plasmid. Finally other therapeutic proteins were dosed in the vitreous cavity (Epo, sTNFR1-Ig). Results: Transscleral injections of naked plasmids (versus PEI) in saline (versus distilled water) was more efficient to transfect reproducibly the ciliary muscle. The optimal electrical conditions were 200V/cm, 8 pulses, 5HZ. Multiple injection sites significantly improved the reproducibility of transfection. The amount of transfected plasmid correlated well with the levels of proteins detected in the vitreous. When no current was applied, a pick of secretion was observed in the vitreous but no sustained protein production. On the contrary, using optimized conditions of electrotransfer, a sustained secretion of gLuc was schieved for at least 5 months. All tested proteins were dosed in the vitreous without any detectable levels into the serum. No major side effects resulted from this smooth muscle tranfection technique. Conclusion: Electrotransfer of plasmids into the ciliary muscle is an easy, reproducible and simple technique to achieve a sustained s e c retion of any therapeutic proteins into the ocular media. Application to neurotrophic proteins or anti-angiogenic approaches are currently evaluated
through ciliary muscle electrotransfer is a promising alternative to repeated intraocular protein administration for a large number of inflammatory, degenerative, or angiogenic diseases.
P18-2 NEURO-BEHCET'S DISEASE Tugal-Tutkun Ilknur ( I s t a n bul Unive rsity Istanbul faculty of Medicine Dept of Ophthalmology) Neurological involvement has been reported in around 5% of patients with Behçet’s disease in large series. Two main forms of neurological involvement are seen: The more common form is the parenchymal involvement which is mainly a meningoencephalitis most frequently involving the brainstem. In about one third of the patients with neuro-Behçet, a non-parenchymal involvement is found which is characterized by venous sinus occlusion that usually presents with raised intracranial pressure, headache, papilledema, and occasionally sixth nerve palsy. Patients with dural sinus thrombosis have a significantly better prognosis than those with parenchymal involvement. Isolated papillitis is a rare manifestation with a good visual prognosis. Financial fundings: (None.) Conflict of interest: None Keywords: Behcet's disease, neurological involvement, prognosis
P17-7 SUSTAINED INTRAOCULAR PRODUCTION OF ANTI TNF PROTEIN FOR THE TREATMENT OF EXPERIMENTAL UVEITIS F Behar-Cohen2,4, E; Touchard 2, C. Bloquel12, L Kovalczuk2 P. Bigey1, D. BenEzra2,3, D. Scherman1, F. 1 Chemical and Genetic Pharmacology Laboratory, INSERM U640 CNRS UMR8151 René Descartes Unive rs i t y, Ecole Nationale Supérieure de Chimie de Paris, Paris, France, 2 INSERM U598 Institut Biomédical des Cordeliers, René Descartes University, Rothschild Ophthalmic Foundation, Paris, France, 3 Hadassah Hebrew Unive rsity Hospital, Je rusalem, I s ra e l , 4 Laboratoire d’Innovations Thérapeutiques, Rothschild Foundation, Paris, France. Introduction: Due to its small size and particular isolating barriers, the eye is an ideal target for local therapy. Recombinant protein ocular delivery requires invasive and painful repeated injections. Alternatively, a transfected tissue might be used as a local producer of transgene-encoded therapeutic protein. We have developed a non-damaging electrically mediated plasmid delivery technique (electrotransfer) targeted to the ciliary muscle, which is used as a reservoir tissue for the long lasting expression and secretion of therapeutic proteins. Results: High and long lasting rep o rter gene ex p ression wa s observe d, wh i ch was re s t ricted to the ciliary mu s cle. Chimeric T N F · soluble receptor (hTNFR-Is) electro t ra n s fer led to elevated protein s e c retion in aqueous humor and vitreous for more than 3 months and to an inhibition of clinical and histological inflammation scores in rats with endotoxin-induced uveitis. Tre atment induced a down regu l ation of iNOS and IL6 and up reg u l ation of IL10. In the retina, p h enotypic ch a n ges could be observed in microglial cells. No hTNFR-Is was detected in the serum, demonstrating the local delivery of proteins using this method. Plasmid electrotransfer to the ciliary muscle, as performed in this study, did not induce any ocular pathology or structural damage. Conclusions: Local and sustained therapeutic protein production
P18-1 NEUROLOGICAL CONCOMITANTS OF UVEITIS Smith Justine R., Rosenbaum T. James (Casey Eye Institute) The eye and the brain share a close anatomical relationship and have common immunological features. Although uveitis is rare among patients with neurological disease, many patients with uveitis suffer from neurological conditions. We conducted a retrospective review of all patients who attended our tertiary referral uveitis service over a 15-year period (Br J Ophthalmology 2004; 88: 1498-9). Of 1450 patients with uveitis, 115 (7.9%) had neurological disease that was causally related to the eye inflammation. Uveitis and neurological disease were most frequently associated in Vogt-Koyanagi-Harada syndrome (n=16), primary CNS lymphoma (n=16), multiple sclerosis (n=14) and herpes virus infections (n=10). A wide variety of other neurological diagnoses, including infections, were more rarely associated with uveitis. In some patients, the uveitis and the neurological disease could not be specifically diagnosed, but the two conditions were considered to be causally related. We conclude that neurological disease is common in patients with uveitis. Recognition of such involvement is important as the neurological diagnosis may have implications for patient management. Financial fundings: (None.) Conflict of interest: (None.) Keywords: neurological disease, uveitis
P18-5 UPDATE ON OPTIC NEURITIS RELATED TO MULTIPLE SCLEROSIS AND CHRONIC INFLAMMATO RY OPTIC NEUROPATHIES CLERMONT-VIGNAL Catherine (Fondation Rothschild, Paris)
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Abstract Book
Acute optic neuritis (ON) is the first attack in multiple sclerosis (MS) in up to 25–50%, and during life, up to 75% of patients will have such visual problems. Natural history of ON is known since a long time but have been clarified recently by the Optic Neuritis Treatment Trial, the Longitudinal Optic Neuritis Study and some large trials in MS. This presentation will review these recent studies. - Visual evolution is good at one year, but the first problem is to find at the onset of ON visual criteria predictive of abnormal 6-month vision. - MRI is the best indicator of the risk of developing MS after ON but if normal, some ocular findings are associated with 0% chance of developing it, and we’ll review them. - The third problem is the question of an early treatment after ON, when MRI is suggestive of MS. Today lot of studies try to answer this question. The final goal is to protect from axonal damage and modify the course of the disease. Mesure of peripapillary retinal nerve fiber layer (RNFL) by OCT is a non invasive method for these studies and some papers try to associate the results with different parameters of visual function (contrast, mean deviation of the visual field, visual potentials..), of MS (Disabililty Score Scale, number of relaps, form of the disease) and to the eventuality of an early disease modifying treatment. Sometimes, p atients develop many re c u rrences of optic neuritis and / or progressive evolution. These chronic optic neuritis occur in MS but also in other conditions such as Devic neuromyelitis optica, sarcoïdosis, CRION, and auto immune optic neuropathies. We will review the recent data about these chronic relapsing inflammatory optic neuropathies . Financial fundings: (None.) Conflict of interest: (None.) Keywords: OPTIC NEURITIS- MULTIPLE SCLEROSIS- PROGNOSIS
P18-7 NEURO-OPHTHALMOLOGIC MANIFESTATIONS OF AIDS Nathalie Cassoux MD, PhD Département d’Ophtalmologie de l’Hôpital Pitié-Salpétrière Paris Neuro-ophthalomologic manifestations can affect 8% of AIDS patients. Since the introduction of highly active antiretroviral therapy (HAART), patients can be divided into 2 groups, those having an immune reconstitution and those having an immunodeficiency. Patients having an immu n o d e fi c i e n cy because the tre atment remains non efficient or because they can not take this expensive therapy for economical reasons, have neuro-ophthalmologic manifestations mostly due to opportunistic infections. Patients with immune reconstitution may present infections mostly related to syphilis but above all, neuro-ophthalmologic manifestations are related to tumors or HAART side effects. Tumors are to date the fi rst cause of death in patients with immune reconstitution. HAART gives an immune recovery but also major side effects (diabetes, hyperlipidemia, hepatic toxicity….), main cause of ischemic optic neuropathy, cerebral stroke, venous thrombosis. Cooperation
with infectiologists is of great importance to know immune status of patients and treatment side-effects.
P19-1 THE ROLE OF MAJOR HISTOCOMPATIBILITY COMPLEX ALLELES IN THE SUSCEPTIBILITY OF BRAZILIAN PATIENTS TO DEVELOP THE MYOGENIC TYPE OF GRAVES ORBITOPATHY Cruz Antonio A V, Akaishi M S Patricia, Rodrigues L V Maria, Mascaro Fabrizio, Maciel Z Lea, Donadi A Eduardo School of Medicine of Ribeirao Preto University of Sao Paulo Objective: To assess the frequency of the genetic markers HLADRB1 and DQB1 in patients with Graves’ orbitopathy (GO) with and without extraocular muscle involvement. Methods: The frequencies of class II HLA-DRB1 and DQB1 allele groups were determined for 81 Brazilian patients with Graves’ orbitopathy and 161 normal subjects. The patients were divided into groups myogenic and non-myo genic based on the clinical characteristics of the orbitopat hy and quantitative computed tomography analysis of the extraocular muscle dimensions. Results: Compared to the frequency obtained for samples of normal subjects of the Brazilian population, HLA-DRB1*16 (pc=0.009) was overrepresented in myogenic patients. Conclusions. The association between the HLA-DRB1*16 and the myogenic subtype of GO suggests that EOM involvement in GO may be genetically determined. Financial fundings: Capes Conflict of interest: None Keywords: Graves' orbitopathy, genetic markers HLA, extraocular muscle enlargement
P19-2 INFLAMMATORY DISEASES OF THE ORBIT Mourits Maarten P (Academic Medical Center) Most patients referred to an orbital unit of a tertiary referral center are suffering from an inflammatory orbital disease. These include Graves’disease, specific and non-specific inflammations and transitional lesions. Of these, Graves’disease due to its relative high incidence and complex management has the greatest impact on facilities and supplies. An overview and differential diagnosis of the most frequent inflammatory orbital diseases will be shown and their pathogenesis and management options discussed focussing on the present state of art as well as on promissing new drugs. Financial fundings: none Conflict of interest : none Keywords: inflammation, auto-immunity, proptosis
P19-6 PARASITIC INFECTIONS OF ORBIT Mohan Ravindra (Sankara Nethralaya,Chennai,INDIA) Parasitic infestations of the orbit,though uncomon,represent a challenge in diagnosis and management.The symptoms and signs vary greatly,depending on the exact location of the parasite and the
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Abstract Book extent of surrounding tissue re a c t i o n . The status of the parasite,whether dead or alive, and the number of parasites in the orbit also influence the clinical picture.As a result, the severity of orbital inflammation varies from the minimal ,to serious orbital cellulitis and abscess fo rm ation.In the absence of infl a m m at o ry signs,a variety of orbital tumors,both benign and malignant may be mimicked.While imaging using ultrasound ,computed tomography and magnetic resonance imaging often gives a clue in the form of specific and diagnostic signs like a scolex in the case of cysticercosis,such features are not always seen,making the diagnosis difficult.Serology is helpful but not always contributory.Medical management with albendazole and oral steroids is an excellent option in the commonest parasitic infestation seen in our centre,orbital cysticercosis.Surgical management is only uncommonly needed in these cases,unlike in rarer infestations like hydatid where a preoperative diagnosis is not always possible.Outcome is usually good.A large series is presented with both the usual and the unusual making up the uncommon,yet important group of orbital parasitic conditions Financial fundings: None Conflict of interest: None Keywords: orbit,parasites,cysticercosis
P19-7 OSSIFYING FIBROMA: A RARE CAUSE OF ORBITAL INFLAMMATION IN CHILDREN Cruz Antonio A V (School of Medicine of Ribeirao Preto University of Sao Paulo), Alencar M Victor (School of Medicine of Ribeirao Preto University of Sao Paulo), Figueiredo R P Ana (School of Medicine of the Federal University of Minas Gerais), Paula Sheila (School of Medicine of Ribeirao Preto University of Sao Paulo), Eichenberger C D Gustavo (School of Medicine of Ribeirao Preto University of Sao Paulo), Chahud Fernando (School of Medicine of Ribeirao Preto University of Sao Paulo) Objective: To describe the clinical and radiological features of four cases of ossifying fibroma affecting the orbit and to review the literature on orbital involvement by the tumor. Methods: Small case series. Results: Four patients (3 children and 1 adult) with ossifying fibromas invading the orbit were examined. Two children presented with ossifying fibromas on the orbital roof. One had the psammomatoid form of the disease and the other the trabecular variant. Despite striking differences in the histological pattern and in the radiological appearance of the lesions, both children displayed a significant degree of orbital inflammation mimicking orbital cellulitis. The third child and the adult patient had their orbit involved by trabecular ossifying fibromas invading the orbital floor. The tumor of the adult clearly originated in the maxilla, filled the maxillary sinus and eroded the orbital floor. The tumor of the third child occupied the maxillary, ethmoid and sphenoid sinuses. In both cases the clinical presentation was painless eye dystopia and proptosis. Conclusions: Regardless of the histologic pattern, trabecular or psammomatoid, ossifying fibromas can induce a substantial degree of orbital inflammation in children and must be included in the differential diagnosis of acute orbit during childhood. Financial fundings: None Conflict of interest: None Keywords: ossifying fibroma, inflammation, orbit
P20-1 MOLECULAR TOOLS FOR DIAGNOSIS OF HERPETIC UVEITIS Sunao Sugita, Manabu Mochizuki Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University Graduate School, Tokyo, Japan. Objectives: Human herpesviruses (HHV) can be classified into eight groups, HHV1-8. However, association of some herpesviruses with clinical entities in the eye is still controversial. This presentation was summarizing our data to measure the genomic DNA of in the ocular fluids and to analyze the clinical relevance of HHV in uveitis. Methods: The 111 ocular fluids (68 aqueous humor and 43 vitreous fluid samples) were collected from 100 patients with uveitis after informed consent was obtained. The samples were assayed for HHV-DNA, h e rpes simplex virus-1 (HSV-1; HHV1), HSV-2 (HHV2), varicella-zoster virus (VZV; HHV3), Epstein-Barr virus (EBV; HHV4), cytomegalovirus (CMV; HHV5), HHV6, HHV7, and HHV8 by two polymerase chain reaction (PCR) assays: a qualitative PCR (multiplex PCR) and a quantitative PCR (real-time PCR). Results: Either HSV1 (n=2), HSV2 (n=3), or VZV (n=11) genome was detected in all tested patients with acute retinal necrosis (n=16). All cases contained high copy numbers of the virus DNA that indicates viral replication. VZV genome was also detected in another 10 patients with iridocyclitis with high intraocular pressure (IOP). EBV-DNA was detected in 19 of 111 samples (17%) using multiplex PCR. However, only 6 of the 19 samples showed significantly high copy numbers of EBV-DNA by real-time PCR. CMV genome was detected in 3 iridocyclitis patients (immunocompetent patients) with high IOP and a CMV retinitis in an immunocompromised patient. A high copy number for the HHV6-DNA was detected in a patient with severe unilateral panuveitis. HHV7- and HHV8-DNA were not detected in all samples. Conclusions: HHV-DNA was detected by a qualitative PCR in ocular fluids of many patients with various uveitis. However, a quantitative real-time PCR is needed to evaluate the clinical and pathogenic relevance of the virus in uveitis.
P20-3 DIAGNOSIS STRATEGIES IN PATIENTS WITH TOXOPLASMIC RETINOCHOROIDITIS Clรกudio Silveira We will discuss classics strategies and new strategies for diagnosis of toxoplasmic retinochoroiditis. The classical strategy begins with the collection of epidemic data to evaluate alimentary habits, contact with the soil and cats. Initial symptoms include floaters and blurred vision due to cells excluding from an active focus of retinitis adjacent to an older scar. The exam of the retina in these cases can show the active retinitis that is glimpsed as a whitish headlight in the fog. The headlight is the active site of the retinitis. In these cases it is high the probability of ocular toxoplasmosis. The ocular tension will be increased significantly in 15% of the cases. In the presence of isolate lesion we should investigate IgG, IgM of peripheral blood and if necessary PCR and Witmer-Desmonts coefficient of the aqueous humor. New strategies: The presence of T. gondii in the peripheral blood during the recurrent retinochoroiditis or first lesion shows that the disease is not an isolate event. The isolation of the parasite also
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Abstract Book allows the investigation of the involved strain (1). Strains mutants / atypical have been related to the severity of the ocular disease (2). The presence of Toxoplasma in the peripheral blood shows that the disease is not a local event and needs a systemic approach. After the treatment it is possible to repeat the exam to confirm if there was elimination or not of the parasites of the peripheral blood. Reference: 1. Khan A, Jordan C, Muccioli C, Vallochi AL, Rizzo LV, Belfort Jr R, Vitor RWA, Silveira C, Sibley LD. Genetic Divergence of T.gondii Strains Associated with Ocular Toxoplasmosis, Brazil. Emerg. Infect. Dis. 12:942-9, 2006. 2. Silveira C, Rios, L, Rizzo LV, Grigg M – III International Congress on Congenital Toxoplasmosis – Colombia, 2007.
occurs in the exudative form of age-related macular degeneration (AMD) and is ch a ra c t e ri zed by ch o roidal neovascularization (CNV) and/or retinal angiomatous proliferation (RAP). It has recently been recognized that complement activation may play an important role in the development of AMD, in particular in aberrant angiogenesis. Although an abnormality in complement activation is likely not the cause of neovascularization, the role of complement – in particular, C5b and the membrane attack complex (MAC) - in the development of CNV will be discussed. Financial fundings: None. Conflict of interest: None. Keywords: complement activation, choroidal neovascularization, age related macular degeneration
P21-3
RESERVA The exam in the slit lamp allows easily identifying iritis and mutton fat precipitating.
IMMUNE RECOVERY UVEITIS IN AIDS PATIENTS WITH C Y TO M E G A L OVIRUS RETINITIS TREATED WITH HAART IN VENEZUELA Arevalo J. Fernando (Clinica Oftalmologica Centro Caracas )
P20-5 UPDATE ON THE DIAGNOSIS OF PRIMARY INTRAOCULAR LYMPHOMA Chan Chi-Chao (National Eye Institute) While a strong clinical suspicion may exist that a patient has primary intraocular lymphoma, the diagnosis can be made only upon the identification of malignant lymphoid cells demonstrated monoclonality in the eye. We recommend the following modern diagnostic approaches: 1. Spinal tap for CSF examination 2. Diagnostic vitrectomy for routine cytology, immunohistochemistry/flow cytometry, molecular analysis for IgH or TCR gene rearrangements, and cytokine measurements (IL-10) 3. Chorioretinal or endoretinal biopsy for histology, immunohistochemistry and molecular pathology 4. Diagnostic enucleation for a blind eye It is important to examine the alive, not necrotic cells; therefore, proper handling specimen and rapid processing are critical. A plan should be designed so that appropriate testing of the tissue is carried out. This requires coordinating care amongst the surgeons, pathologists, microbiologists, and molecular biologist. The information obtained from the biopsy can often lead to a change in clinical management with benefits seen in the patient’s vision and, in the case of pri m a ry intraocular lymphoma, extension of the patient’s life. Financial fundings: NEI intramural research program Conflict of interest: none Keywords: primary intraocular lymphoma, monoclonality, IL-10
Introduction and objectives: To determine characteristics of immune recovery uveitis (IRU) in acquired immunodeficiency syndrome (AIDS) patients with inactive CMV retinitis who responded to highly active antiretroviral therapy (HAART). Methods: Patients were followed for a median of 36.2 months following increase in CD4 count. The occurrence of IRU was defined as symptomatic (vision decrease and/or floaters) vitritis of 1+ or greater severity associated with inactive CMV retinitis. Macular edema or epiretinal membrane formation was determined by clinical examination, fluorescein angiography, and optical coherence tomography. Four eyes were treated with sub-Tenon triamcinolone injections, and 4 eyes have been treated with intravitreal triamcinolone injections. Results: Sixteen (25%) of 64 HAART responders developed IRU (24 eyes). The clinical spectrum of inflammation included vitritis, macular edema, ep i retinal membra n e s , a n t e rior uve i t i s , and cataract. Eyes with IRU had a CMV surface area with a mean of 29.5%. Local corticosteroid treatment resulted in vision improvement (in 50% of eyes) without reactivation of retinitis. One eye developed a combined central retinal vein and artery occlusion after intravitreal triamcinolone acetonide. Conclusions: Symptomatic IRU develops in a significant number of patients with CMV retinitis following successful HAART. Eyes with IRU respond favorably to anti-inflammatory therapy without reactivation of retinitis. Financial fundings: The Arevalo-Coutinho Fo u n d ation fo r Research in Ophthalmology, Caracas, Venezuela Conflict of interest: None Keywords: CMV retinitis, HAART, Immune recovery uveitis
P21-1 AMD: INFLAMMATION AND ABERRANT ANGIOGENESIS Kaplan Henry J (Unive rsity of Louisville), Bora S Nalini (University of Arkansas) Angiogenesis is a dynamic process that occurs throughout the body involving the development and involution of neovasculature in response to physiologic stress. Aberrant angiogenesis in the eye
P21-4 FAMILIAL GRANULOMATOUS ARTHRITIS AND UVEITIS: THE ROSETTA STONE OF UVEITIS Rosenbaum James T., Martin R. Tammy, Planck R. Stephen, Davey P. Mich a e l , Rosenzweig Holly (Oregon Health & Science University) A single base pair substitution in the nucleotide binding domain of
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Abstract Book the NOD2 gene can result in a rare, autosomal dominant inflammation known as familial granulomatous uveitis and arthritis or Blau Syndrome. Identical de novo mutations cause inflammation sometimes diagnosed as early onset sarcoidosis. Polymorphisms primarily in the leucine rich repeat domain of the NOD2 gene predispose to the granulomatous bowel disease, Crohn’s disease. The NOD2 gene is a member of the NLR family of genes that function as intracellular pathogen recognition receptors and which regulate inflammation. The NOD2 gene is able to sense the ubiquitous component of bacterial cell walls, muramyl dipeptide (MDP). NOD2 interaction with MDP results in activation of the transcription factor, NFkB, and synthesis of a variety of cytokines including interleukin-1 (IL-1). In a mouse model of MDP-dependent eye inflammation, interleukin-1 is induced but inflammation is not IL-1 dependent. Clarifying the mechanism by which NOD2 contributes to eye inflammation has the potential to elucidate the pathogenesis of more common forms of uveitis. Financial fundings: N ational Eye Institute Stan and Madelle Rosenfeld Family Trust Research to Prevent Blindness Conflict of interest: None Keywords: Uveitis, NOD2, muramyl dipeptide
P21-5 THE ROLE OF OPHTHALMIC EXAMINATION IN THE DIAGNOSIS OF SYSTEMIC INFECTIONS Khairallah Moncef (Tunisia) Bacterial, viral, fungal, and parasitic pathogens all cause clinical or subclinical systemic infection and can spread to the eye, resulting in symptomatic or asymptomatic ocular involvement. A close collaboration between infectious disease specialist and ophthalmologist is mandatory to ensure successful visual and systemic outcome. It is well-established that in patients with intraocular inflammation an infectious cause should be ruled out first, using a systematic approach, based on history, a comprehensive ocular and physical examination, and guided tests. Infectious disease specialist may help ophthalmologist in identifying and treating the underlying infectious disease. In the other hand, a systematic and careful ocular examination in patients with systemic infection with or without ocular complaints may assist in early diagnosis and institution of appropriate therapy. The role of ophthalmic examination in the diagnosis of systemic infections is discussed, with a review of literature and presentation of practical cases. Financial fundings: (None.) Conflict of interest: No Keywords: Ophthalmic examination, fundus examination, systemic infections
P21-7 TUBERCULOSIS AND OCULAR INVOLVEMENT IN ITALY, AN OLD NEW PROBLEM Tognon Sofia (University of Padua -Italy- Ophthalmology Unit) Menolascina Luisa (University of Padua -Italy- Ophthalmology Unit), Secchi Antonio (University of Padua -Italy- Ophthalmology Unit), Sattin Andrea (University of Padua -Italy- Infectius Diseases Unit), Castellani Elena (University of Padua -Italy- Infectius Diseases Unit)
Introduction and aim: In recent times Tuberculosis (TB) is becoming a severe public health problem in the Western countries of Europe where it was considered almost disappeared from the last century’s years ‘40s onward. The present paper deals with a prospective study of ocular involvement in patients with confirmed extraocular tuberculosis, afferent in the last 3 years to the Ophthalmology Unit and Infectious Diseases Unit in our Hospital – which is a tertiary care reference point for the North-East Of Italy. Patients and methods: In the last 3 years we underwent a complete ophthalmologic examination in 189 consecutive patients with systemic confirmed primary or secondary TB, either pulmonary or extra-pulmonary. The actual incidence of ocular involvement, and the predisposing factors for that, have been taken into consideration. Clinical Results: In 189 patients with systemic Tuberculosis 43(22%) developed ocular disease, particular corioretinitis or panuveitis. 33(80%) of these 43 patients with ocular involvement had extrapulmonary disease. 2 patients(5%)were HIV positive with miliary TB, 33 patients(80%) were Italian and, among Italians, 25 (76%) were over 60 year old, unlike non–italian patients which were all under 40 years old . Conclusion: The prevalence of Ocular Tuberculosis, as well as Tuberculosis in general, is clearly increasing also in Italy. 22% of systemic TB patients seen in the last 3 years have ocular involvement. More frequently uveitis was associated with secondary, extra-pulmonary TB disease. This increased morbidity seems to be somehow related to the HIV pandemia,to the immigration from areas with high prevalence of TB, bat in our experience more closely to the progressive aging of Italian population. The possible predisposing factors for TB recapture in the old Italian population will be analysed, and we will underline the new problem of TB in industrial countries. Financial fundings: (None.) Conflict of interest: (None.) Keywords: TUBERCULOSIS ,EYE, EPIDEMIOLOGY
P22-1 TYPES OF NEOVASCULARIZATION IN INFLAMMATORY EYE DISEASES Arellanes Lourdes (Asociación Para Evitar la Ceguera en México) Ocular neovascularization is one of the complications associated to uveitis. It is more frequent in retina and optic disc, but it can affect other tissues as iris, ciliary body and choroid. Chronic and severe infl a m m ation may induce new vessel formation; retinal non perfusion has also an important role in promoting neovasculari z ation. Although both, infl a m m ation and ischemia may contribute to neovascularization in some cases, in others an adequate control of the inflammat o ry response may induce new vessel regression. Demonstration of retinal non perfusion on fl u o rescein angi ograp hy is an indication for additional tre atment with laser photocoagulation. A graphic review of different types of ocular neovascularization and associated diseases will be presented. Financial fundings: None Conflict of interest: None Keywords: Ocular inflammation, complication, new vessels
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Abstract Book
P22-3 PHOTODYNAMIC THERAPY IN SUBFOVEAL IDIOPATHIC AND POSTINFLAMMATORY CHOROIDAL NEOVASCULARIZATION Ruiz-Moreno Jose M Montero A Javier Objectives: To evaluate the efficacy of photodynamic therapy (PDT) in the treatment of idiopathic and inflammatory choroidal neovascularization (CNV). Methods: Non-randomized, multicentre, interventional case series. Sixteen eyes of 16 patients with classic or predominantly classic suband juxtafoveal idiopathic CNV and 26 eyes of 24 patients with classic or predominantly classic sub- and juxtafoveal CNV secondary to inflammatory conditions were treated with PDT with verteporfin. Best corrected visual acuity (BCVA) before and after PDT, the number of lines gained or lost and the number of PDT sessions we re analysed. Results: The mean follow-up was 20 months (SD 11) and 16 months (SD 9) for the idiopathic and inflammatory groups, respectively. The mean BCVA in idiopathic CNV changed from 0.63 logMAR (SD 0.37) before treatment to 0.82 logMAR (SD 0.43) after treatment (p = 0.16; Student's t-test paired data). The number of treatments performed averaged 2.1 (r ange 1-4, SD 0.9). The mean BCVA in postinfl a m m atory CNV ch a n ged from 0.60 logMAR (SD 0.4) before treatment to 0.57 logMAR (SD 0.6) after treatment (p = 0.79; Student's t-test paired data). The mean number of treatments was 2.6 (range 1-6, SD 1.2). Conclusions: PDT may be useful in stabilizing BCVA in patients with sub- and juxtafoveal postinflammatory CNV and subfoveal idiopathic CNV. Financial fundings: None Conflict of interest: None Key wo rds: P h o t o dynamic therapy, n e ova s c u l a ri z ation, ocular inflammation
P22-4 SURGICAL TREATMENT- DOES IT HAVE A ROLE IN INFLAMMATO RY CHORO I DAL NEOVA S C U L A R I Z ATION? Arevalo J. Fernando (Clinica Oftalmologica Centro Caracas ) Introduction and objectives: To summarize and to discuss the results of the main submacular surgical procedures for inflammatory choroidal neovascularization (CNV) as reported in the literature and to compare them to recent studies and data on anti-angiogenic therapy. Methods: The existing data in the literature on submacular surgery were evaluated. The main outcomes were proportion of patients with two or more lines of improvement in visual acuity (VA) and proportion with two or more lines of deterioration in VA after surgery and compared with anti-vascular endothelial growth factor (anti-VEGF) data or combined therapy with anti-angiogenics. Results: Estimates for the treatment outcome within the four groups of treatment based on a logistic regression model gave comparable results for removal of choroidal neovascularization (CNV) (improvement of VA 28%, deterioration of VA 25%), macular translocation (improvement of VA 31%, deterioration of VA 27%), and for transplantation of pigment epithelium (improvement of VA 22%, deterioration of VA 21%). Estimates for removal of subretinal hemorrhage were significantly different (improvement of VA 62%, deterioration of VA 13%). However, our data on intravitreal
(IVT) bevacizumab (Avastin) demonstrated improvement in 72.7% of eyes, with a mean foveal thickness decreased from 374 μ at baseline to 270 μ (p = 0.001) at final visit. Conclusions: Selected case series and our data showed superior functional results compared to submacular surgery studies for inflammatory CNV. In our opinion there seems to be very limited justification for submacular surgery today. Financial fundings: The Arevalo-Coutinho Fo u n d ation fo r Research in Ophthalmology, Caracas, Venezuela Conflict of interest: None Keywords: Anti-VEGF, Inflammatory CNV, Submacular surgery
P22-6 BEVACIZUMAB THERAPY OF CNV ASSOCIATED TO TOXOPLASMOSIS Alain Zourdani, Martine Mauget-Faysse*, Eric Souied, Gabriel Coscas, Gisèle Soubrane Département d’Ophtalmologie Universitaire de Créteil, Paris XII *Centre d’Ophtalmologie Rabelais de Lyon Introduction and objectives: The prognosis of ocular toxoplasmosis is favorable in immunocompetent individuals, as long as the central macula is not directly involved. Appearance of subfoveal choroidal neovascularization is a major complication and cause of vision loss. The purpose is to evaluate the efficacy and safety of Intra vitreal Bevacizumab with subfoveal choroidal neovascularization (CNV) in the scar associated with toxoplasmic retinochoroiditis. Methods: Bevacizumab treatment is alternative option for this patients with subfoveal CNV associated with toxoplasmic retinochoroiditis. During follow-up, fundus, color photographs, fluorescein and/or indocyanine green angiography, and optical coherence tomography were performed. The decision to retreat CNV was based on the same criteria used in PDT and anti VEGF treatment for Age-Related Macular Degeneration. Results: No significant adverse effects of Bevacizumab were observed during the follow-up. Significative reduction of edema and CNV perfusion were a principal results obtained. Conclusions: Bevacizumab for subfoveal CNV associated with toxoplasmic retinochoroiditis appears to be effective and safe even in young adults and children. However, a longer follow-up is recommended to confirm our observations. Financial fundings: (None.) Conflict of interest: (None.) Keywords: CNV, TOXOPLASMOSIS, BEVACIZUMAB
P23-1 CRYOTHERAPY AND LASER FOR INTERMEDIATE UVEITIS Montero Javier A (Vissum, Alicante Institute of Ophthalmology), Ruiz-Moreno M Jose (Vissum, Alicante Institute of Ophthalmology) Introduction and Objective: The management of intermediate uveitis (IU) usually involves the use of corticosteroids and other immunosuppresors, associated with surgical approaches including
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Abstract Book vitrectomy, laser and cryotherapy. The aim of this presentation is to revise the performance of laser photocoagulation and cryotherapy over the peripheral retina and the ciliary body to reduce intraocular inflammation and to induce regression of neovascularization. Methods: The indications, procedure and complications of laser photocoagulation and cryotherapy to treat IU are described. Results: Cryotherapy to the snowbanking is indicated in cases of snowbanks associated with reduced visual acuity, non responsiveness to steroidal therapy and neovascularization. Laser may be performed as local or panretinal photocoagulation to treat areas of neova s c u l a rization associated with ischemia and inflammation. Photocoag u l ation may also be perfo rmed to the bord e rs of retinoschisis areas. Complications associated with cryotherapy are phthisis bulbi, epiretinal membranes, retinal detachment and vitreoretinal haemorrages. Complications associated with laser photocoagulation are recurrences of neovascularization, vitreoretinal haemorrages, retinal detachment, epiretinal membranes, retinal holes and progression of retinoschisis. Conclusion: Management of IU is based on a step by step approach, with steroids as the first stage of therapy. Other therapeutical approaches may reduce the inflammation, the need for steroids and the complications.
P23-5 DIAGNOSTIC VITRECTOMY Nathalie Cassoux MD, PhD Département d’Ophtalmologie de l’Hôpital Pitié-Salpétrière Paris Diagnostic vitrectomy is the main way to diagnose posterior uveitis resistant to corticosteroids. Ocular lymphoma is the first cause of tumoral mascarade syndrome. Vitrectomy with cytological analysis, cytokines measurements, polymerase chain reaction (PCR) for clonal Ig rearrangements provides a diagnosis in up to 70% of cases. Il-10 measurements in aqueous humor and vitreous is of a great help for screening and diagnosis of ocular lymphoma. If an ocular infection is suspected, the progress made in molecular biology detecting pathogen agents in vitreous make us able to diagnosed diseases previously consider idiopathic. Diagnostic procedure became a safe and rapid surgical procedure using the 25 gauge vitrectomy device. Indications, decisional algorithm and surgical procedure will be discussed.
P24P25-1
Financial fundings: None Conflict of interest: None Keywords: Intermediate uveitis, photocoagulation, cryotherapy
CLASSIFICATION CRITERIA IN SYSTEMIC IMMUNE MEDIATED DISEASES (IMIDS) van Hagen P. Martin (Erasmus MC), Baarsma Seerp G. (Eye Hospital Rotterdam)
P23-4
Standardized nomenclature and classification are necessary in order to distinguish patients with a specific IMID from those who have another disease. This is especially important in IMIDs, because many diseases are syndromes with overlapping clinical features. Laboratory tests may contribute to a diagnosis but are seldom diagnostic tests. Classification criteria for IMIDs serve an important function in the interpretation of: - epidemiological studies - clinical research - clinical trials Without standardized definitions it is impossible to interpretate, incidence and prevalence, morbidity rates, mortality and so on. Criteria can be used to make a diagnosis or to describe a disease process. For example in systemic lupus erythematosus (SLE) criteria sets are developed to describe the disease process, to classify the disease activity, and to describe organ damage. International collaboration is warranted, by ensuring that the classification criteria describe the same disease entity and/or disease activity. In the study of ocular involvement in systemic disease it is of vital importance to define the IMID and/or disease activity scores according to the internationally accepted classification criteria.
PERIPHERAL RETINAL COMPLICATIONS OF UVEITIS Marc D. de Smet, ZNA Middelheim Campus, Antwerp, Belgium. BACKGROUND A number of patients with uveitis will develop in the course of their disease peripheral retinal complications which will require surgical repair. These may include: retinal detachment (1% idiophathic, 3+% post infectious), retinal necrosis, or hypotony. METHODS The key to successful surgery lies in (1) pre-operative and perioperative control of inflammation, (2) avoidance of unnecessary surgical trauma (cryocoagulation, large gauge openings), (3) optimized but aggressive vitreous removal, (3) minimizing the use of external re-inforcements (buckles), (4) optimal use of tamponade agents whose choice is dependent on the severity of the intraocular inflammation. In addition, the removal of the posterior hyaloid membrane and the internal limiting membrane should be attempted and may require the use of staining agents to facilitate an atraumatic removal in non infectious cases. To manage hypotony, the cause must be identified. In the presence of adequate ciliary processes, removal of vitreous adherent to the processes will lead to improved aqueous production and vision. In the absence of functional processes, the patient will require permanent tamponade with silicone oil. CONCLUSION With a well planed surgical procedure, re-attachment rates are over 75%. The most important prognostic factors appear to be pre-operative vision, severity and type of inflammation (granulomatous is worse), presence or absence of PVR.
R e fe re n c e : G ab riel SE Classification of rheumatic diseases. Rheumatology, third edition, vol 1, p9-12;2003 Financial fundings: (None.) Conflict of interest: (None.) Keywords: Classification, rheumatic, ocular
P24P25-6 IMPORTANCE OF CLASSIFICATIONS IN CLINICAL TRIALS Marc D. de Smet, ZNA Middelheim Campus, Antwerp, Belgium.
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Abstract Book AL INJECTION, BACKGROUND Few randomized clinical trials have ever been carried out in ocular inflammation. The absence of clearly defined, clinically relevant endpoints is one of the main reasons why such trials are absent, and a frequently stated reason why big Pharma has shown little interest in conducting trials in uveitis. METHOD Using existing studies from the literature on AMD, CMV retinitis, and rheumatology as wel as recent studies on Infliximab, the relevance and need for endpoints will be discussed. RESULTS Selection of appropriate endpoints depends on the clinical situation being evaluated and the objective. With AMD, vision improvement is a necessary requirement, CMV retinitis resolution of activity while accepting a minimum of progression in the first few weeks. In uveitis studies, the aim can be reduction in drug use, lowering of side effect, or improvement in vision. Each endpoint is relevant to patients, but none have been validated. CONCLUSION Valid clinical endpoints are re q u i red in uveitis studies. Concentrating only on visual improvement is inappropriate in several uveitis conditions. However, validation of useful endpoints is required and should be the object of studies by societies such as the IOIS.
P27-2 INTRAVITREAL INJECTION: SELECTING DRUG, BALANCING THE RISKS. AVASTIN RESULTS Bonafonte Sergio (Centro de Oftalmología Bonafonte. Barcelona) There is an important controversy about access to new treatments for choroidal neovascularisation, macular oedema and other ocular diseases. We will explain how to select the correct anti-VEGF drug balancing the risk and considering economics, ethics and medicolegal problems. Before 2005, patients with neovascular membranes were treated with laser (5%), photodynamic therapy (PDT) (20%), TTT or left untreated, usually suffering severe and permanent visual loss. The PDT treatment is expensive and characterised by a progressive loss of vision, requiring an average of 5.5 treatments over two years. In 2005 a quiet revolution occurred in ophthalmology and for the first time in history we have treatments (intravitreal ranibizumab or bevacizumab) which stabilise or improve vision in a great majority of patients with wet ARMD and around 35% of treated eyes achieve driving-level vision (only 3% PDT-treated eyes). Intravitreal triamcinolone (iVTA) is an inexpensive drug w i d e ly available as “off-label” t re atment in retinal diseases. Despite the large number of publications, its efficacy is in doubt with still very limited data on long-term efficacy . The complications of using iVTA are common and the ocular morbidity is high. At this moment our indications of iVTA are very limited. We have no experience with pegabtanib. We will present our results after 2 years of using bevacizumab impressed by the safety record and cost effectiveness of this drug. We call for clinical trials comparing ranibizumab and bevacizumab. Financial fundings: (None.) Conflict of interest: (None.) Keywords: anti-VEGF DRUG, BEVACIZUMAB, INTRAVITRE-
P27-4 ONE YEAR EXPERIENCE WITH THE USE OF INTRAVITREAL RANIBIZUMAB (LUCENTIS) IN THE MANAGEMENT OF CHOROIDAL NEOVASCULARIZATION DUE TO WET AGE RELATED MACULAR DEGENERATION. JIMENEZ JAIME (SOUTHERN EYE CENTER) INTRODUCTION: CHOROIDAL NEOVASCULARIZATION (CNV) DUE TO WET AGE RELATED MACULAR DEGENERATION (AMD) IS THE LEADING CAUSE OF NEW BLINDNESS IN PEOPLE OVER 55 YEARS OF AGE. RANIBIZUMAB (LUCENTIS) BINDS AND INHIBITS VASCULAR ENDOTHELIAL GROWTH FACTOR-A (VEGF-A), A PROTEIN THAT IS BELIEVED TO PLAY A CRITICAL ROLE IN THE FORMATION OF NEW BLOOD VESSELS. IN JUNE 2006 THE UNITED STATES FOOD AND DRUG ADMINISTRATION (FDA) APPROVED LUCENTIS FOR THE USE IN WET AMD BASED ON DATA FROM TWO LARGE PHASE III CLINICAL TRIALS (MARINA AND ANCHOR). THIS PRESENTATION WILL EVALUATE THE ONE-YEAR CLINICAL EXPERIENCE IN A PRIVATE RETINA PRACTICE SETTING AND WILL PRESENT PATIENT EVALUATION, INJECTION TECHNIQUES, MANAGEMENT OF COMPLICATIONS AND VISUAL OUTCOMES. METHODS: A REVIEW OF PATIENTS TREATED FOR CNV DUE TO AMD WITH MONTHLY INTRAVITREAL LUCENTIS FROM JULY 1, 2006 TO JUNE 30, 2007 WAS MADE. EVALUATION INCLUDED VISUAL ACUITY (VA), OPTICAL COHERENCE TOMOGRAPHY (OCT-3) AND FLUORESCEIN ANGIOGRAPHY (FA). TREATMENT DECISIONS WERE MADE AFTER ASSESSING THE VA, PRESCENCE OF SUBRETINAL FLUID (SRF) AND CYSTIC RETINAL CHANGES DOCUMENTED CLINICALLY OR BY OCT-3 AS WELL AS LEAKAGE ON FA. COMPLICATIONS AND THEIR MANAGEMENT WERE NOTED AND VISUAL ACUITY RESULTS WERE ASSESSED. RESULTS: A TOTAL OF 2,459 INJECTIONS WERE DONE. THERE WAS A MARKED TREND FOR IMPROVEMENT OF VA IN MOST PATIENTS EARLY DURING THE TREATMENT (3 INJECTIONS) AND OTHERS IMPROVED LATER (6 TO 9 INJECTIONS). VISUAL IMPROVEMENT WAS MAINTAINED DURING TREATMENT AND DETERIORATED AFTER CESSATION. THERE WAS A STRONG CORRELATION BETWEEN THE PRESCENCE OF SRF AND CYSTIC RETINAL CHANGES AND DECREASED VISION. COMPLICATIONS INCLUDED CORNEAL ABRASIONS (2), RETINAL PIGMENT EPITHELIAL (RPE) TEARS (1), IRITIS (1), ENDOPHTHALMITIS (1), RETINAL TEAR (1) AND RETINAL DETACHMENT (1). CONCLUSIONS: LUCENTIS IS A VERY EFFECTIVE WAY TO INHIBIT THE NEOVASCULAR RESPONSE IN AMD AND IMPROVE VA. COMPLICATIONS ARE FEW AND EASILY MANAGED MEDICALLY OR SURGICALLY. Financial fundings: NONE Conflict of interest: NONE Keywords: RANIBIZUMAB (LUCENTIS), CHOROIDAL NEOVASCULARIZATION, INTRAVITREAL INJECTIONS
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 34
Abstract Book S1-4 UVEITIS, INFECTIONS AND CORTICOSTEROIDS Bahram Bodaghi, MD, PhD Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France Infectious uveitis may induce different types of inflammatory reactions. Diagnostic confirmation remains a major issue in order to evaluate the importance of associated corticosteroids. Even though they are not required in patients with bacterial infections such as, Whipple’s disease, tuberculous choroiditis and most cases of syphilis, they are highly efficient in different cases of toxoplasmic retinochoroiditis, anterior viral retinitis, immune recovery uveitis and Lyme disease. Molecular mimicry and Toll-like receptors may play a role in the pathogenesis of different post-infectious inflammatory disorders. In the absence of anti-inflammatory molecules, visual prognosis may be guarded despite specific antimicrobial agents. Viral replication may be dramatically increased by corticosteroids leading to severe complications, especially in patients with poorly controlled necrotizing herpetic retinopathies. In order to avoid these challenging situations, corticosteroids will be initiated if viral replication has been previously controlled. The use of quantitative PCR, showing a significant decrease of viral loads, is a helpful tool in these cases. Clinical presentations may be atypical for different infectious agents masquerading as an auto-inflammatory process. Resistance of an idiopathic uveitis to high dose corticosteroids or immunosuppressors needs further investigations, in order to exclude an infectious origin. Tubercular serpiginouslike choroiditis and nonnecrotizing herpetic retinopathies are two newly described entities with good response to specific antibacterial or antiviral agents. The use of PCR technology will be helpful for the identification of other similar conditions.
S1-6 GOOD PRACTICES IN CORTICOPTHERAPY Marc D. de Smet Division of Vitre o retinal surge ry, Z NA Middelheim Campus, Antwerp, Belgium Corticotherapy has been an integral part of ophtalmic practice since the late 1940s. While indispensable as a therapeutic modality, its use is associated with significant systemic and/or local side effects. A series of guidelines can be proposed for their appropriate use, and can be summarized as follows: (1) Rule out or treat concurrently infections (2) Establish your treatment target adequately (3) Prefer more local over broader delivery mechanisms when possible (4) Embrace preparations with appropriate penetrance (5) Anticipate side effects (6) Leave room for reassessment and patient participation
temic treatment of these conditions. Although used as the basis for control of ocular inflammatory disorders, corticosteroids are burdened with myriad adverse effects. Owing to a need to minimize corticosteroid-induced side effects, immunosuppressive drugs are used. Methods: A review of the risk versus benefits of current treatments for uveitis will be discussed. Conclusions: Meticulous attention to laboratory and physical findings coupled with a systematic approach to care will maximize the potential for control of disease while minimizing side effects. Financial fundings: LUX Biosciences Conflict of interest: Supported by LUX Biosciences Keywords: UVEITIS, THERAPY, CYCLOSPORIN
S2-3 LX211: FEATURES & THE LUMINATE PROGRAM Zierhut Manfred (Germany) Introduction: LX211 is a novel, next-generation calcineurin inhibitor possessing a extended therapeutic window as compared to other agents in the class allowing for potent immunosuppression with potentially fewer adverse effects while obviating the need for therapeutic drug monitoring. The safety and efficacy of LX211 has been evaluated previously in non-ophthalmic indications including psoriasis and renal transplantation. Methods: The LUMINATE (Lux Multicenter Investigation of a New Approach to Treatment) Program in Uveitis consists of 3 randomized, prospective, double-masked, placebo-controlled, doseranging studies of LX211 for systemic therapy in: (1) active sightthreatening uveitis affecting primarily the posterior segment of the eye [LUMINATE Active]; (2) clinically quiescent sight-threatening i n t e rm e d i ate-, posteri o r- , or panu veitis [LUMINATE Maintenance]; (3) active sight-threatening uveitis affecting primarily the anterior segment of the eye [LUMINATE Anterior]. The primary endpoint will assess the mean change in inflammation from baseline. Secondary endpoints include reduction of corticosteroid dosing, mean change in best corrected visual acuity, assessment of fl u o rescein angi ographic ch a n ge s , optical cohere n c e tomography and quality of life. Results: These studies are currently underway at centers in the US, Canada, Germany, France, Austria, the United Kingdom and India. Conclusions: These studies comprise the first large, prospective, randomized trials of a therapeutic agent for the treatment, control and maintenance of an immunomodulatory agent for non-infectious uveitis.
S2-2
S2-4
RISK VERSUS BENEFIT OF UVEITIS TREATMENTS Foster C. Stephen (Massachusetts Eye Research and Surgery Institute)
EMERGING OUTCOME PARAMETERS IN UVEITIS Bodaghi Bahram (La Pitié-Salpétrière Hospital, Paris, France)
Introduction: The potential for vision loss associated with ocular inflammatory disorders is substantial. Moreover, their association with generalized disorders underscores the frequent need for sys-
Introduction: The goal of therapy for sight-threatening uveitis is the suppression of inflammatory activity. Clinical studies of agents for severe uveitis may evaluate the therapeutic response of either
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 35
Abstract Book active sight-threatening uveitis or the ability to maintain disease in an inactive state while tapering of other medications is undertaken. In either case, the endpoint is based on the use of semi-quantitative scales of inflammation (e.g. vitreous haze, anterior chamber cells). Methods: The use of additional parameters to assess visual function and structural status including optical cohenrence tomography and laser flare photometry for the evaluation of macular edema and anterior segment inflammation respectively will be discussed. Conclusions: The use of parameters to assess visual function and structural status in uveitis may supplement methods used currently in the assessment of patients in uveitis clinical trials.
S2-5 LX201 - A NEW TREATMENT PARADIGM FOR PENETRATING KERATOPLASTY SUGAR ALAN (Kellogg Eye Center, University of Michigan) Introduction: C y cl o s p o rine A (CsA) may be effec t ive in preventing rejection, a leading cause of corneal transplant failure, but systemic use has significant risks and topical eye d rop use may not be effective. A silicone mat rix CsA eluting drug implant (LX201) can be placed b e n e ath the conjunctiva and release drug continu o u s lyfor at least one ye a r. In animal studies CsA levels 1 to 2 log units higher than ach i evable systemically can be re a ched in ocular tissues. Methods: The LUCIDA (Lux corneal transplant implant and advancement of therapy) multi-center, randomized, parallel-group dose ranging, placebo controlled trials will test the efficacy and safety of the silicone CsA eluting implants in human subjects. In the LX201-01 study 175 subjects at high risk for corneal transplant rejection will receive an active 18.75 mm (n=70), an active 12.25 mm (n=70) or a placebo 18.75 mm (n=35) implant at the time of corneal transplantation. All will receive topical steroid therapy. In the LX201-02 study 270 subjects who have experienced at least one rejection episode fo l l owing penetrating ke ratoplasty will receive the 18.75 mm, 12.25 mm or 18.75 mm placebo implant in a 1:1:1 randomization. All will be followed for 1 year. The primary endpoint will be evidence of graft rejection or failure. Secondary endpoints will be graft vascularization, visual acuity and corneal thickness. Results: These studies are currently underway at corneal transplant centers in the US, Germany and India. Conclusions: These studies offer a new approach to the prevention of corneal transplant rejection and may improve graft outcomes. Financial fundings: Lux Biosciences, Inc. Conflict of interest: Research grant funding and travel expenses from Lux Biosciences, Inc. Keywords: Corneal transplant, rejection, Cyclosporine
children and young adults. The disease may lead to major suffering in the afflicted individual. Patients with ocular allergy complain of redness, itching, tearing, photophobia, mucus discharge and blurring of vision. Several surface allergy may occur including vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis, seasonal allergic conjunctivitis and perennial allergic conjunctivitis. Several cells and mediators play a role in the immunopathogenesis of ocular allergy, and a cascade of chemical mediators and reactions are involved. Conjunctival biopsy specimens of patients with active ocular allergy demonstrated infiltration by lymphocytes, plasma cells, eosinophils, basophils and mast cells. We have found in limbal conjunctival biopsy specimens obtained from patients with VKC a marked increase in Langerhans cells, T lymphocytes and mast cells. Mast cells appear to play a crucial role in the pathogenesis of ocular allergy, and phenotypically distinct mast cell populations may express different functions in health and disease. Methods: We assessed the ocular manifestations and complications of patients with VKC. A total of 58 consecutive patients; 52 boys and 6 girls, aged 8-17 years with severe VKC were examined. Patients were deemed to have severe VKC if they had symptoms for at least two years and had diffuse palpebral conjunctival edema and thickening with papillary hypertrophy (P3) and giant papillae. All patients had limbal infiltration of 180째 or more. Results: Twelve patients (21%) had a best corrected visual acuity in one or both eyes of 20/200 or less, 20 (34%) had 20/50 to 20/200 vision, and 26 (45%) had 20/20 to 20/50 vision. The ocular complications that led to visual loss among 32 patients included steroidinduced cataract, steroid-induced glaucoma, central corneal scars, irregular astigmatism, keratoconus, and limbal tissue hyperplasia. Twelve out of the 32 patients had dry eye syndrome. Conclusions: Severe VKC may occur and may represent a potentially blinding disorder. Visual loss may be due to corneal complications, including corneal scars, astigmatism and keratoconus, as well as complications of the unsupervised use of topically administered corticosteroids. References: 1. A bu El Asrar AM, Al-Mansouri S, Tabbara KF. Immunopathogenesis of conjunctival remodelling in vernal keratoconjunctivitis. Eye 2006;20(1):7-19. 2. Abu El-Asrar AM, Geboes K, al-Kharashi SA, Al Mosallam AA, Tabbara KF, Al-Rajhi AA, Missoten L. An immunohistochemical study of collagens in tra choma and ve rnal kerat o c o n j u n c i t ivits. Eye 1998;12:101-106. 3. Tabbara KF. Tear tryptase in vernal keratoconjunctivitis. Arch Ophthalmol 2001;119(3):338-342. 4. Tabbara KF. Ocular complications of vernal keratocojunctivitis. Can J Ophthalmol 1999;34(2):88-92.
S3-4 S3-2 OCULAR MANIFESTATIONS AND COMPLICATIONS OF VERNAL KERATOCONJUNCTIVITIS Khalid F. Tabbara, MD The Eye Center and The Eye Foundation for Research in Ophthalmology Riyadh, Saudi Arabia Background: Ocular allergy can be a disabling allergic disease of
PRESENTLY AVAILABLE TREATMENT MODA L I T I E S FOR VKC Andrea Leonardi. Ophthalmology Unit, Department of Neuroscience, University of Padua, Italy Multiple pro-inflammatory and regulatory pathways are activated in VKC and play a significant role in the development of the dis-
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 36
Abstract Book ease. Current drug treatment targets only some of the key mechanisms involved in the development of VKC: mast cells with mast cell stabilizers, histamine with histamine receptor antagonists and inflammation with corticosteroids. However, none of these agents completely abolishes signs and symptoms. Treatment preferences for VKC should be based on severity of the condition, allergens involved and duration of potential exposure, the drug safety profile, patient expectance and preference, cost and potential side effects. Even mild and moderate forms of VKC, if not appropriately treated, can worsen and cause signs and symptoms that interfere with personal and family life. In severe forms, the patients’ or parents’ tolerance to the condition can lead to steroid abuse. It is essential to inform the patients on the possible consequences of treatments and mistreatments and to plan an appropriate pharmacological and nonpharmacological management. Mast cell stabilizers, topical and systemic antihistamines, and multiple acting agents can be initially used at high frequency. Additional pulsed topical corticosteroid treatment is frequently necessary to further down-regulate the inflammation. Cyclosporine A 1% or 2% in castor oil has been used for treating severe VKC as an off-label alternative to steroids. New therapeutic strategies are still needed to respond to the complex pathogenesis of severe forms of VKC.
S3-5 THE USE OF CSA EYE DROPS IN SEVERE CASES OF VKC David BenEzra - BenEzra Eye Institute, Assuta Medical Center, Rishon, Israel Acute Vernalis or vernal conjunctivitis (VC) is a seasonal manifestation observed in children (mostly boys) during the spring season. Unlike the typical seasonal allergic conjunctivitis (SAC), it is characterized by profuse mucus discharge. Because of this outstanding manifestation it has been coined "Spring Catarrh". In some cases, although remaining more severe during spring and summer time, the manifestations are observed year round. These patients generally develop keratitis and the disease takes the form of vernal keratoconjunctivitis (VKC). Due to the corneal affection, photophobia, itching, grittiness and pain develop inducing severe functional disability. Corticosteroids have remained the mainstay of medical treatment in severe forms of VKC. Unfortunately, long standing and frequent corticosteroid administration are associated with severe secondary complications. Moreover, it is the clinical experience of many practitioners that the use of corticosteroids in these cases, although initially very efficient, is responsible for the chronic recurrences characterised by increasing severity. Faced with these seve re cases and their complicat i o n s , I initiat e d, in 1984, the treatment of severe VKC cases with cy cl o sp o rin A (CsA) eye drops in olive oil. Preliminary attempts had demonstrated that the 2% solution was more effective than the 0.5 or the 1.0 %. Therefore, 12 patients with severe VKC not responding to the conventional therapy and management and/ or developing secondary complications to corticosteroids were enrolled. They received a controlled protocol treatment of 2% CsA solution in olive oil solution and were followed. This formulation was found very effective controlling the ongoing disease manifestations in most of treated cases (BenEzra et al. AJO, 1986). Following these original findings, we studied additional cases and confirmed these initialobservations. During the years, others have corroborated our findings and have reported on the efficacy of 2 % CsA in oil solution. With increasing experience, we realised that many children developed intolerance to the oily formulation. Furthermore, it become evident that
continuous treatment was needed and that recurrences were the rule after the CsA instillations were stopped. From our studies and those of others, we learned the following: 1- CsA eye drops in oily solution were efficient 2- A high concentration of 2% was needed 3- Children developed intolerance to the solution 4- Recurrences of manifestations and signs were the rule when instillations were decreased or stopped Thus, it was evident that a better formulation of CsA was needed. The development by NOVAGALI of VEKACIA may be the long awaited breakthrough for the treatment of severe VKC. The NOVAGALI formulation, the rational behind it and the results of a multi centre international study will follow this presentation.
S3-6 PRECLINICAL DEVELOPMENT OF CYCLOSPORINE A EYE DROP EMULSION GREGORY LAMBERT(FRANCE)
A
NEW
Cyclosporine A (CsA) has been used for treating immune-related eye conditions during the last decades. Due to the low aqueous solubility of CsA it was not possible to prepare conventional aqueous eye drops; therefore compounded solutions in oil were used. These solutions such as CsA 2% in olive oil are poorly tolerated and only a low fraction of the administered dose is absorbed in the eye, the rest being potentially systemically absorbed after elimination from the eye surface to the nasal duct and the gastro-intestinal tract. The ideal eyedrop formulation is a formulation which would combine good ocular tolerance, optimal CsA delivery to eye tissues and at the same reduces the risk of systemic passage. To evaluate CsA formulated in Novasorb® cationic nanoemulsion technology (0.025, 0.05 and 0.1 % (w/w), ocular tolerance and comparative pharmacokinetic studies were conducted. Ocular tolerance was evaluated by administering four times a day 50 μL of each formulation in the rabbit eye for 28 days. Evaluation consisted in clinical observations (eye & main body organs) and histology of the eyes. Different pharmacokinetic studies were conducted on New Zealand white rabbits comparing Novasorb® emulsions at 0.025, 0.05 and 0.1% with Restasis® and a solution of CsA at 2% in olive oil. In addition systemic absorption of CsA was evaluated by HPLC-MS. Regarding tolerance, no significant sign of irritation was observed for the three tested emulsions during the 28 days. Single dose pharmacokinetic studies showed a four-fold (0.1%), two-fold (0.05%) and equivalent (0.025%) corneal and conjunctival CsA exposure compared to Restasis® (0.05%). Furthermore, corneal concentrations of CsA (Figure 1) showed a Cmax of 750 ng/g for Restasis® and about 1400 ng/g for cationic emulsion at 0.05%. It should be emphasized that for cationic emulsion at 0.05%, the corneal concentration at 12 hours is equivalent to the one obtained with
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 37
Abstract Book Restasis at 20 minutes (Cmax). Comparing cationic emulsion at 0.1% and 0.05% versus oil solution at CsA 2% showed about tenfold increase in CsA delivery in the corneal and conjunctival tissues. In the comparative pharmacokinetic studies, a quantifiable whole blood level could only be detected in one animal treated with olive oil 2% (2.16 ng/ml, LLOQ=2 ng/mL). To conclude Novagali’s cationic emulsions of CsA showed a good ocular and systemic safety in rabbits. Pharmacokinetics showed an optimal CsA delivery to eye tissues compared to Restasis® (0.05%) and oil solution at 2%.
(TEAEs) were reported, the most frequent being eye disorders of mild intensity. The tested formu l ations were rated as comfortable by 94.4% (vehicle), 79.5% (Vekacia® 0.05%) and 80.6% (Vekacia® 0.1%). Blood levels of CsA we re assayed after one month of treatment in 16 patients treated with Vekacia® and five patients had detectable CsA levels below 0.33ng/ml, a value which is considered as negligi bl e Efficacy was maintained over the three additional months of treatment with both Vekacia® 0.05% and Vekacia® 0.1%.
S4-3 S3-7 RESULTS OF A PIVOTAL PHASE III IN V E R NA L KERATOCONJUNCTIVITIS (VKC) WITH VEKACIA®, A CYCLOSPORINE A CATIONIC EMULSION Sylvie Eliafoeillet (France) The study was designed as a clinical phase II/III, multicenter, randomized parallel group, double masked, dose ranging, controlled study divided in two treatment periods: • period I: a four-week prospective, randomized, multicenter, double-masked, three parallel-group, vehicle-controlled treatment period; and • period II: a three-month prospective, multicenter, double-masked treatment period. The primary objective of Vekacia® phase III study was to assess the efficacy of Vekacia® 0.05 % and Vekacia® 0.1%, administered four times daily, versus a vehicle after a four-week treatment period for patients with VKC. The secondary objectives were to compare the safety and ocular tolerance (objective and subjective) and the long-term safety after four months. One hundred and eighteen patients (mean age: 8.8) with active bilateral VKC (acute or chronic) were enrolled in the study at over 21 sites in Europe and Mediterranean countries from May 2006 to October 2006. Most patients were suffering from perennial VKC (90 patients, 76.3%) and were presented at study entry with a mixed form of VKC (87 patients, 73.7%). Vekacia® improved both signs and ocular symptoms of VKC in children who received treatment. The superiority of Vekacia® over its vehicle has been demonstrated by the statistically significant improvement of both objective signs of VKC and keratitis in treated patients. Both doses were safe and well tolerated. Local tolerance at instillation was satisfactory and therefore compliance to the recommended dose regimen of four instillations per day was good. Systemic exposure to CsA was negligible in the treated patients. Compliance to the study regimen of four daily instillations of the drug was excellent. Overall improvement of subjective symptoms (burning/stinging, tearing, itching, pain, sticky eyelids, foreign body sensation, mucus discharge and photophobia) was superior to the vehicle for both concentrations of Vekacia®. For objective signs (conjunctival erythema/hyperhemia, conjunctival chemosis and discharge, papillae, limbal infiltrates and corneal epithelial disease), there was a statistically significant diffe rence between both concentrations of Vekacia® and the vehicle treatment (p=0.0386 and 0.0208 for the Vekacia® 0.05% and Vekacia® 0.1% treatment arms, respectively). Similarly, improvement in superficial keratitis was statistically significant with Vekacia® 0.05% versus vehicle (p=0.0176). At one month of study, only seven patients had withdrawn from the study, which comprised four patients using the ve h i cle and three patients using Vekacia®, including one case of ocular intolerance following study drug instillation. Few treatment-emergent adverse effects
EMERGING TRENDS IN PREVENTION OF OCULAR INFECTIONS FOLLOWING CATARACT SURGERY Barequet Irina S. (Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel) Introduction and objectives: To present the risk factors and e m e rging trends in prevention of ocular infections fo l l owing cataract operation. Methods: The current guidelines for antisepsis as well as the current ap p ro a ch to peri o p e rative antibiotic pro p hylaxis will be reviewed. The role of 4th generation fluoroquinolones in modern prophylaxis, by providing safe and efficient cover for many resistant bacteria will be described. Results: There is an increase in the incidence of postoperative endophthalmitis related to clear corneal incisions used in cataract surgery. Several risk factors have been identified, including the location and architecture of the surgical incision. Several prophylactic measures are commonly used, such as povidone–iodine application and postoperative injection of subconjunctival antibiotics. However, with the common use of topical anesthesia, additional means of administration of prophylaxis are becoming important. Several studies showed that topical application of Vigamox has excellent intraocular penetration, achieving levels above the MIC's of most ocular pathogens, and thus providing effective prophylaxis in the early postoperative period. Conclusions: The broad-spectrum, high potency and excellent penetration of topical Vigamox can serve as safe and effective measures to prevent postoperative endophthalmitis after cataract surgery. Financial fundings: Travel grant from Alcon Conflict of interest: (None.) Keywords: endophthalmitis prevention, prophylaxis, 4th-generation fluoroquinolone antibiotics
S5-2 CLINICAL EXPERIENCE WITH INTRAVENOUS IMMUNOGLOBULIN (IVIG) FOR THE TREATMENT OF BIRDSHOT RETINOCHOROIDOPATHY. N. Cassoux, P.Lehoang Dep. d’Ophtalmologie de l’Hôpital PitiéSalpétrière Paris IVIg treatment is successfully used in a growing number of autoimmune conditions. Birdhsot retinochoroidopat hy is a bilat e ral a u t o i m mune posterior uveitis wh i ch re q u i res in severe cases immunosuppressive therapy. Based on analogies with experimental autoimmune uveoretinitis in animals immunized with retinal antigens and treated with IVIg we conducted an open prospective study including 18 patients. Patients were treated with IVIg alone at 1.6g/kg every 4 weeks during 6 months followed by infusions of 1.2-1.6 g/kg every 8 weeks. Visual acuity increased or remained stable in 33 of the 36 eyes at the end of a mean follow-up of 39
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 38
Abstract Book months. We also evaluate IVIg safety and effectiveness in a retrospective study of 37 patients. Mild side effects were observed leading to a discontinuation of the treatment in only 3 patients. We also showed that IVIg had a corticoid sparing effect in patients treated with corticosteroids.
S6-2 EPIDEMIOLOGICAL STUDY OF UVEITIS IN UNIVERSITY HOSPITALS IN FRANCE B. B o d ag h i1, A.Sanchez-Poton2, Fre n ch Severe Uveitis Study Group 1Department of Ophthalmology, University Pierre & Marie Curie, Paris, France; 2Biostatem, Castries, France. Purpose : To determine the distribution and characteristics of severe uveitis, referred to university referral centres (URC) in France during a 3-month period. Methods : All new cases of uveitis referred between January and April 2006, to 31 specialized URC, for diagnostic or therapeutic management were prospectively reviewed. Characteristics of ocular inflammation were reported at the end of the first examination on a questionnaire and collected for further analysis. Results : During this three-month period, 527 patients were finally included. Median age was 44.1 (range 1-95) and the sex-ratio was 1. The majority of patients (60.92%) were referred by their ophthalmologist and no previous episode of uveitis was noted in 62.75% of cases. Acute-onset uveitis was present in 68.22% of cases. Anterior uveitis was the most common type of presentation (54.7%) followed by panuveitis (21.1%), posterior uveitis (18.1%) and intermediate uveitis (6.1%). Complications at referral included a visual loss < 20/100 (20%), posterior synechiae (21.6%), secondary glaucoma (15.3%), cataract (7%), macular edema (7.8%) and retinal necrosis (1.7%). An infectious entity was suspected in 27.8% of cases. Among these patients, a viral infection was suspected in 11.6% of cases followed by toxoplasmic retinochoroiditis in 10.2% of cases. A noninfectious etiology was proposed in 46% of cases, including B27-like uveitis in 15.5% of cases and sarcoidosis in 10.5% of cases. Conclusions : Even though classical forms of acute anterior uveitis are still referred to tertiary eye care centres, severe presentations of posterior or panuveitis should be managed properly. Initial ophthalmological examination is a key step for the diagnostic and therapeutic management of these patients. An infectious etiology may be easily suspected and should be excluded before the further use of corticosteroids or immunosuppressive drugs.
S7 UVEITIS CYSTOID MACULAR EDEMA UME â&#x20AC;&#x201C; uveitis macular edema is one of the most devastating complications which a patient may develop usually after a lengthy and chronic course of uveitis. This satellite symposium will attempt to give attendees a current overview of the magnitude of the problem from an epidemiologic perspective and its implication for vision. Current knowledge on its pathogenesis will be covered as well as current diagnostic and therapeutic modalities. Finally after an overview on novel therapeutic modalities which are now being developed, a discussion with clinical experts in the field will follow where attendees will also be given an opportunity to ask questions.
S8-1 NEW CLASSIFICATIONS AND PATHOGENESIS OF DRY EYE DISEASE Baudouin Christophe (Quinze-Vingts National Ophthalmology Hospital) New classifications and new mechanistic schemas of dry eye disease (DED) have been recently proposed, in order to complete the classic etiological approaches. Inflammation and hyperosmolarity a re now emphasized as key mechanisms. Another sch e m at i c approach proposes two levels of ocular surface impairment, with standard etiologies being not independent diseases but risk factors and/or ways to enter a self-stimulated biological process involving the ocular surface. All external disorders proposed on the schema are classical causes of tear film impairment and ocular surface damage, by tear instability and evaporation, tear hyposecretion or both. These mechanisms, either alone, when severe or becoming chronic or repeated, and in cases of association of two or more, may lead the patient to enter the self-stimulated loop. Tear film instability or hyposecretion can be considered as the central key points of DED. They will cause hyperosmolarity of the tear film and therefore of superficial epithelial cells of cornea and/or conjunctiva, stimulating epithelial cells and resident inflammatory cells. Cell damage that will result at levels of cornea and conjunctiva, by mean of apoptosis, from direct mechanical and/or osmotic stress, will stimulate the reflex neurosensory arc, stimulating lacrimal gland and neurogenic inflammation, with inflammatory cytokine release, MMP activation and inflammatory involvement of the conjunctival epithelium. Goblet cell loss is thus directly related to chronic inflammation and hyperosmolarity, resulting in enhancement of tear film instability/imbalance. This proposed schema should be considered as a basis for further reflection on biological mechanisms that could be even more complex but individually constitute potential tracks for targeting therapeutic strategies in order to allow patients to leave the loop even though the triggering factor(s) are still present or can only be attenuated, such as in SjĂśgren syndrome or ocular rosacea. Financial fundings: No specific funding Conflict of interest: No conflict of interest Keywords: Ocular surface, Dry eye, inflammation
S8-4 ANTIMICROBIAL SURFACE
PEPTIDES
OF
THE
OCULAR
Antimicrobial peptides (AMPs) are the eukaryotic analogues of antibiotics. They are recognised as one of the earliest effectors of the innate immune response and as such are widely distributed throughout the plant and animal kingdoms with remarkably conserved structures. In addition to their antimicrobial activity, these peptides can signal to host cells and are therefore intermediaries between the innate and adaptive immune systems. It is believed that Toll Like Receptors (TLRs), a range of of which have also been shown at the ocular surface, participate in such interactions. The ocular surface is endowed with a generous range of AMPs including Beta defensins 1-4, Cathelicidin, Leap 1 and 2. Recently we have demonstrated another novel defensin, DEF-109 and another AMP, RNAse, at the ocular surface. The expression of AMPs in health and ocular surface disease, including keratitis, conjunctivitis and dry eye, has been studied. Some AMPs are consistently increased, others variably so and DEF-109 is decreased, in inflammation. This talk will provide an overview of the spectrum of
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 39
Abstract Book antimicrobial peptide expression at the ocular surfaces. AMPs have mplications in the normal homeostasis of mucosal surfaces and a potential for novel antimicrobial and anti-inflammatory therapies.
S8-5 THERAPEUTIC STRATEGIES IN DRY EYE Creuzot Catherine (Department of Ophthalmology) Dry eye is a complex disease due to a decrease in aqueous secretion or increased evaporation of tears, both conditions often associated. The hallmark of ocular dryness is an increased inflammation inducing in turn a deleterious effect on conjunctival and corneal cells. The first line treatment of ocular dryness should be to treat the causative problem of dry eye (ie hormonal environment) but unfortunately the main target of treatment remains rather the consequences of the disease. However, as evaporative and secretory aetiologies are often linked, the common approaches to treat dry eye mainly are mainly based on environmental strategies to correct the risk factors, tear supplementation, devices to increase tear retention, attempts to stimulate tear secretion, use of biological tear substitutes or anti-inflammatory therapy and finally diet rich in essential fatty acids. In addition, the treatment of evaporative dry eye disease is mainly based on lid hygiene, frequent saline use and in some cases, cyclines. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Tears:dry eye:treatment
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 40
Abstract Book OP1-01 ANTIGEN PRESENTING CELLS IN INTRAOCULAR TISSUES Yamaki Kunihiko, Kamaya Shuhei, Gotoh Yoko (Department of Ophthalmology, Nihon Medical School Chiba Hokushouh Hospital) Introduction: Antigen presenting process in intraocular tissues is not well known. To clarify the antigen presenting process in intraocular tissues, we analyzed the cells that have potentials to present peptide antigens to immune cells. Materials and Methods: CSEF labeled 12 mer peptide(TRP11819) was injected into intraocular tissues (anterior chamber, intra vitreous, subretinal space, and/or choroid) of Lewis rats with or without LPS or Interferon-g. The eye balls were enucleated 3, 12 and 24 hrs after injection . The enucleated eyeballs were embedded with OCT compound followed by freezing in liquid nitrogen. The frozen sections were fixed and stained with fluorescent labeled OX6, OX62, CD200, CD1, Cd14, TLR4, Cd11b, ED1, Ki-M9R, CD80, CD86, CD40. Results: CSEF labeled peptide was not incorporated in normal eye. In the eye 3hr, 12hr and 24hr post injection of peptide with LPS into anterior chamber, the peptide was incorporate by various kinds of cells in anterior chamber, iris and ciliary body. In the eye 3hr, 12hr and 24hr post injection of peptide with LPS into posterior segments of the eye, retinal pigment epithelium (RPE) incorporated the peptide and the cells located around RPE incorporated the peptide. These cells were consisted by various kinds of cells. One was Class II, CD14 and TLR-4 positive cells. The others were ED1, KiM9R positive and CD1, CD11b positive cells Conclusions: In the intraocular tissues, the were various kinds of cells that may have the potentials to present the antigens to immune cells (T cells). Financial fundings: Japanese ministry of education culture and sports Conflict of interest : none Keywords: APC, LPS, TLR-4
OP1-02 KILLER IMMUNOGLOBULIN LIKE RECEPTOR GENES IN BIRDSHOT CHORIORETINOPATHY Levinson Ralph D (Jules Stein Eye Institute UCLA), Brezin P Antoine (Hopital Cochin), Monnet Dominique (Hopital Cochin), Du Zieyang (UCLA), Cohen HM Jacques (UCLA Immunogenetics Center), Rajalingam Raja (UCLA) Introduction: Killer immunoglobulin-like receptor (KIR) genes code for both activating and inhibitory receptors. It has been suggested that the balance of these receptors may be important in determining the immune responsiveness of not only NK cells, but T cells as well. While HLA-A29 is strongly associated with birdshot chorioretinopathy (BCR), it is a rare disease even in HLAA29+ individuals; clearly other genetic and environmental factors are important. Our objective was to evaluate the role of KIR genes in conferring risk for BCR. Methods: We examined the KIR genetic profile of 110 patients with BCR seen at Hopital Cochin, Paris, France, and 100 HLAA29+ and 100 HLA-A29 - local controls. Results: Gene clusters coding for predominantly activating KIR receptors were more common in patients compared to HLA-A29+ controls (63% vs 21% respectively), whereas gene clusters coding
for with predominantly inhibitory KIR receptors were less common in patients compared to HLA-A29+ controls (8% vs 42% respectively). Among genes for inhibitory KIR receptors, the combination of 3DL1 and HLA-Bw4 and 2DL2/3 and HLA-C1 was more common in patients than HLA-A29+ controls, but was more common in HLA-A29+ controls than in HLA-A29- controls. 3DL1 is important in educating or "licensing" NK cells to enhance activation, and 2DL2/3 is the weakest inhibitory receptor. A pattern of HLA-A29+ c o n t rols being interm e d i ate between HLA-A29- controls and patients with BCR was seen in several of our analyses. Conclusions: KIR genes appear to confer risk for BCR. In addition, there is evidence that HLA-A29 and KIR genes may have been co-selected in our French cohort. This may be part of the explanation for the observation that BCR is more common in Caucasians than other groups in which HLA-29 + individuals are not rare. Financial fundings: MacDonald Family Foundation Conflict of interest : None Key wo rds: B i rdshot ch o rioretinopathy, KIR ge n e s , immunogenetics
OP1-03 COMPARISON BETWEEN LATS AND ICP0 T R A NSCRIPTS DURING HSV1 LATENCY 1 IN A MURINE MODEL OF OCULAR HERPETIC INFECTION Labetoulle Marc (Ophthalmology Dept, Hopital de Bicetre, South Paris Unive rsity) Crépin Sophie (Lab o rat o i re de Viro l ogie Moléculaire et Structurale, CNRS UMR 2472, Gif/Yvette), Maillet Séverine (Laboratoire de Virologie Moléculaire et Structurale, CNRS UMR 2472, Gif/Yvette), Nordmann Patrice (Microbiology Dept, Hopital de Bicetre, South Paris University), Offret Hervé (Ophthalmology Dept, Hopital de Bicetre, South Paris University), Naas Thierry (Microbiology Dept, Hopital de Bicetre, South Paris University) Objectives: The latent infection by Herpes simplex virus type 1 (HSV1) is classically characterized by the only accumulation of Latency-Associated Transcripts (LATs), which have an anti-apoptotic role and participate to protect the reservoir of latently infected neurons. We showed that another viral gene is transcribed during experimental latent infection, coding for the viral protein ICP0 that is mandatory for viral reactivation. Material and methods: The wild type strain SC16 of HSV1 was inoculated in the lip of Balb/c mice. Animals were sacrificed at 6 days (primary infection) and 28 days (latent infection) post-inoculation. The quantification of ICP0 transcripts and LATs by real time RT-PCR was performed in the trigeminal and cervical superior ganglia, the spinal cord and the hypothalamus. Results: Both LATs and ICP0 transcripts were found in the four sites of HSV1 latency, with different proportions with regard to the location. In particular, the trigeminal ganglion was characterized by an accumulation of both LATs and non-spliced ICP0 transcripts, while a decrease was observed in the other sites of HSV1 latency. Conclusions: The results suggest a relation between LATs and the maturation of ICP0 transcripts, which could be involved in the maintenance of HSV1 latency. These data also demonstrate that different neurons results in distinct behavior of the virus during the latent phase of infection. Comparing various sites of latent infection thus improves the relevance of observations made in animal models of HSV1 infection.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 41
Abstract Book Financial fundings: Agence Nationale de la Recherche, Association des Amblyopes UnilatĂŠraux Conflict of interest : None Keywords: Herpes simplex virus, latency, reactivation
OP1-04 ROLE OF OSTEOPONTIN IN EXPERIMENTAL AUTOIMMUNE UVEORETINITIS IN MICE Kitamura Mizuki1, Kitaichi Nobuyoshi1, Namba Kenichi1, Uede Toshimitsu2, Onoe Kazunori3, Ohno Shigeaki1 1 (Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan) 2 (Division of Molecular Immu n o l ogy, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan) 3 (Division of Immunobiology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan) Introduction and objectives: Osteopontin (OPN), an acidic phosphoglycoprotein, contains the arginine-glycine-aspartic acid (RGD) cell-binding sequence that is found in many extracellular matrix (ECM) proteins. OPN acts as a cytokine contributing to the development of Th1-biased immunity. Experimental autoimmune uveoretinitis (EAU) is an organ-specific T cell mediated disease that targets retina and choroids. In the present study, role of OPN in EAU was examined to determine whether OPN could be a therapeutic target for the disease. Methods: C57BL/6 (B6, 6~8 wk) and OPN-deficient (B6 background) mice were immunized subcutaneously in the neck and b a ck with human interp h o t o re c eptor retionoid-binding pro t e i n (hIRBP) peptide 1-20 emu l s i fied in CFA containing Mycobacterium tuberculosis strain H37Ra. Concurrent with the immunization, p u ri fied Bordetella pertussis toxin (PTX) wa s intraperitoneally injected as an additional adjuvant. Plasma levels of OPN were measured by sandwich enzyme-linked immunosorbent assay on day 3, 7, 10, 14, 21, and 28 after immunization. Clinical assessment by funduscopic examination of the retinal inflammation was carried out every 3 or 4 days from day 7 after immunization. For the histological assessment of EAU, eyes were enucleated on day 21 after immunization and the severity of EAU in each eye was evaluated. Moreover, hIRBP-immunized wild type (WT) mice were administered M5 antibody reacting to SLAYGLR sequence, a cryptic binding site to integrins within OPN, and clinical and histological examinations were performed. Results: Plasma OPN was elevated in EAU model with WT mice that had been immunized with hIRBP peptide 1-20 accompanying EAU progression. OPN-deficient mice showed milder EAU progression in clinical and histopathological scores compared with those of WT mice. EAU development was significantly ameliorated by M5 antibody. Conclusions: These results indicate that OPN may represent a novel therapeutic target to control uveoretinitis. Financial fundings: This work was supported in part by a grant for re s e a rch on sensory and commu n i c at ive disord e rs from The Ministry of Health, Labor, and Welfare Japan, by Grants-in-Aid for S c i e n t i fic Research (S) and (C) from Japan Society for the Promotion of Science (JSPS) and a Grant-in-Aid for Scientific Research on Priority Areas from The Ministry of Education, Culture, Sports, Science and Technology (MEXT) Japan. Conflict of interest: We have no potential conflict of interest. Keywords: EAU, cytokine, inflammation
OP1-05 THE NEUROPROTECTIVE EFFECTS OF ANTAGONISTS OF LYSOPHOSPHATIDIC ACID RECEPTORS DURING OXYGEN-INDUCED RETINOPATHY Yang Chun (research center, hospital ste-justine, University de Montreal) Introduction and Objective: Exposure to variable oxygen concentrations predisposes the preterm retina to developing retinopathy of prematurity. It has been demonstrated that hypoxia induces retinal ganglion cell (RGC) death through an apoptotic pathway. Moreover, transient global retinal ischemia is known to upregulate the expression of lysophosphatidic acid (LPA) receptors. LPA receptor signalling was suggested to mediate neuroprotection in acute retinal ischemia. This study investigated the contribution of LPA receptor antagonists towards the death of RGCs in a model of oxygen-induced retinopathy (OIR). Methods: OIR was induced by exposing rat pups on postnatal day 0 to alternating cycles of hyperoxia/hypoxia for 14 days. RGCs were quantified in vivo via retrograde labelling with FluoroGold. The expression of LPA receptors in both RGC and retinal ganglion cell line (RGC-5) was assessed by immunohistochemistry and Western blot respectively. Intravitreal injections with the antagonists of LPA receptors were administered during oxygen-treatment and their effects on RGC survival were evaluated. In vitro, RGC-5 were treated with staurosporine to induce differentiation and subsequently exposed to hypoxia in the presence or absence of LPA receptorsâ&#x20AC;&#x2122; agonist or antagonists. Cell viability and neurites outgrowth were then compared to those in normoxia. Results: We found RGC express both LPA1 and LPA2 receptors. OIR significantly reduced the number of RGC in rat pups and this effect was prevented significantly with the LPA1 antagonist. In vitro, LPA1 antagonist also prevented hypoxia-induced RGC-5 death and stabilized the neurite network. Conclusions: Our results suggest that during retinal oxidative stress, inhibitors of LPA1 receptor exert neuroprotective effect. Financial fundings: CIHR Conflict of interest : none Key wo rd s : retinal ganglion cell, receptor,oxygen-induced retinopathy
lysophosphatidic
acid
OP1-07 BIOMARKERS OF AUTOIMMUNE-MEDIATED RETINAL DEGENERATION: A 40-KDA RETINAL AUTOANTIGEN Adamus Grazyna, Mosgrove Lori, Weleber G. Richard (Oregon Health & Science University) Introduction: Paraneoplastic and autoimmune retinopathies (AR) are associated with circulating anti-retinal autoantibodies and retinal degeneration. The experimental and clinical studies corroborate that autoantibodies in high titers can penetrate into the retina affecting function of the target antigens, which leads to retinal dysfunction and degeneration. Anti-recoverin (23-kDa), and anti-enolase enolase (46-kDa) autoantibodies were more frequently associated with AR but autoantibodies with other specificities have also been documented. Our goal is the identification of AR-specific autoantibodies - biomarke rs for better diagnosis and prognosis of retinopathies. Methods: Patients with unexplained acquired visual symptoms of possible retinal origin were referred for evaluation. Retinal function was evaluated by ophthalmologic examination, including elec-
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 42
Abstract Book troretinography. Sera were tested by immunohistochemistry and Western blotting. Results: Of 225 patients (34 with cancer) 137 (60.8%) had autoantibodies against various retinal proteins. Anti-·-enolase antibodies were demonstrated in 38 patients and anti-recoverin antibodies in 2 patients. Autoantibodies to a 40-kDa protein (31/137 seropositive patients) were more frequently detected than antibodies with other specificities. Patients with autoantibodies against 40-kDa retinal autoantigen were younger (54.6 years old) than typical CAR patients (63 years old) and were represented by a majority of women at the ratio ~2:1. Only 6 patients have been previously diagnosed with cancer. Bilateral visual loss of sudden onset, defects in visual fields and reduced ERG scotopic responses were characteristic. Using proteomic and immunochemical analysis a 40-kDa autoantigen was identified as ·-transducin in the majority of these patients. Conclusion: Retinal autoantigens can be used as biomarkers for different subtypes of AR. Anti-recoverin autoantibodies are associated with cancer and almost equal loss of rod and cones system, indicating widespread dysfunction. Anti-enolase retinopathy typically presents with cone dysfunction and is equal in cancer and non-cancer patients. Patients with anti-transducin antibodies have defects in rod (scotopic) photoreceptor function and typically do not have cancers. Financial fundings: NIH grant EY13053 Conflict of interest: None Keywords: retinopathy, autoimmunity, retinal autoantigens
OP1-08 RELEVANCE OF ANTI-CARBONIC ANHYDRASE II AUTOANTIBODIES IN AUTOIMMUNE RETINOPATHY Adamus Grazyna, Karren Landon (Oregon Health & Science University) Introduction: Autoimmunity has been proposed as a possible etiol ogic factor of retinal dege n e ration. Carbonic anhydrase II (CAII) is one candidate a target autoantigen recog n i zed during the autoimmune response observed in some fo rms of retinopathies. A broad o c c u rrence of anti-CAII in other diseases led to questions concerning the role of CAII in the pat h ogenesis of autoimmune retinopathy. Methods: Patients with unexplained acquired visual loss were referred for ophthalmologic and immunological evaluation. Sera were obtained from these patients and tested by Western blotting and ELISA for anti-CAII antibody titers. CAII activity and intracellular pH were determined in retinal E1A.NR3 cells, which were incubated with various concentrations of affinity purified anti-CAII autoantibodies. Results: We found there were higher antibody levels of anti-CAII in 20 patients with retinopathies than in the control group. Six patients with cancer (2 colon, 2 prostate and 2 lungs) had anti-CAII autoantibodies, which suggest that these autoantibodies have been generated during the process of anti-cancer immune responses. Anti-CAII antibodies were also found in the vitreous of a retinopathy patient. In in vitro assays we showed that anti-CAII autoantibodies inhibited the CAII catalytic function and had a moderate effect on intracellular pH in retinal cells. Also, these autoantibodies had a cytotoxic effect on retinal cells. Discussion: Serum autoantibody to CAII may be detected in retinopathy patients as a consequence of anti-tumor response or the immune response against other antigens, which mimic CAII. There was not a good correlation of retinal presentation with anti-CAII
antibodies. The anti-CAII antibodies are more likely to be a general indication of autoimmune process than a biomarker for a specific autoimmune retinopathy subtype. However, antibodies can be transported into the retinal cells and it is possible that they contribute to the destruction of retinal cells by changing intracellular pH. Financial fundings: NIH grant EY13053 Conflict of interest : none Keywords: autoimmunity, retinopathy, carbonic anhydrase II
OP1-09 IMPAIRED CYTOKINE PRODUCTION OF TUMOR INFILTRATING LYMPHOCYTES IN A MODEL OF PRIMARY INTRAOCULAR B-CELL LYMPHOMA Touitou Valérie1, Bodaghi Bahram1, de Kozac Yvonne2, LeHoang Phuc1, Fridman Catherine2, Fisson Sylvain2 1 Pitié Salpetriere Hospital, Paris 2 Centre de Recherche des Cordeliers, Paris P ri m a ry intraocular lymphoma (PIOL) is a high grade nonHodgkin lymphoma which pathogenesis is still unclear. Few animal models exist in order to study this condition. Most of them are T-cell lymphoma but recently, a major step forward has been realized with the development of new models of intraocular B-cell lymphoma. We discuss and evaluate the contribution of the different animal models available for intraocular lymphoma. Moreover, to evauate the role of the immune microenvironment in this condition and to characterize the cytokine polarization of infiltrating T-lymphocytes (TIL), a murine model of intraocular B-cell lymphoma was developed in immunocompetent hosts after intravitreal injection of a syngeneic lymphomatous B-cell line. Clinical, histological and flow cytometric analysis were performed in order to characterize the tumoral invasion and the immune infiltration. Cytokine production of ocular cells was investigated by RTPCR and fluorescent immunoassay with or without stimulation by anti-CD3 plus anti-CD28 antibodies. Intraocular lymphoma developed in all eyes injected by lymphomatous B-cells. Up to 15% of living cells were T-lymphocytes. Cytokine profile analysis of the supernatant of ocular cells cultured ex vivo demonstrated the presence of IL10, IL6, IFNÁ, and TNF·. Stimulation of ocular cells with anti-CD3 plus anti-CD28 antibodies increased the IFNÁ level, and led to the induction of IL2 production, completing the type 1 (Th1/Tc1-like) pattern of cytokine expression observed. IL6 and IL10 levels were not modified. IL12p70 and IL4, potent Th1 or Th2 differenciating factors, were undetectable even after stimulation. Our results suggest that TIL from intraocular B-lymphomas are characterized by a Th1/Tc1 like profile that could be partially inhibited in vivo. These data raise the possibility of an in situ T-cell immunostimulation in order to reactivate the Th1/Tc1 lymphocytes and improve the intraocular anti-tumoral immunity. Financial fundings: None Conflict of interest : None Keywords: lymphoma, cytokine, tumor
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 43
Abstract Book OP1-11 ALPHA A CRYSTALLINS PROTECT THE RETINA IN EXPERIMENTAL UVEITIS Rao Narsing A., Saraswathy Sindhu, Wu Guey-Shuang (Doheny Eye Institute) Purpose: Photoreceptor mitochondrial oxidative stress is detected in the early phase of experimental autoimmune uveitis (EAU) before macrophages infiltrate the retina/uvea. However during this stage the photoreceptors do not reveal apoptosis. In the present study we attempted to evaluate ·A-crystallin upregulation and its anti-apoptotic protective role in early EAU. Methods: The early EAU retina was submitted for detection of highly upregulated crystallins and ·A upregulation was confirmed by real-time polymerase chain reaction and Western blot, and the site of upregulation was localized by immunohistochemistry. The binding of ·A-crystallin to nitrated cytochrome c and interaction with a procaspase-3 subunit was assayed. The site of mitochondrial oxidative stress was localized by immunocytochemistry. Results: In early EAU, ·A-crystallin was increased 33-fold and the site of increase was localized to photoreceptor inner segments. This crystallin suppressed apoptosis by binding to the nitrated cytochrome c and to p24. The site of oxidative stress was seen primarily in the photoreceptor inner segments. Conclusions: ·A-Crystallin is profoundly upregulated in the retina during early EAU. This upregulation is localized primarily in the photoreceptor inner segments, the site of mitochondrial oxidative stress. Further, in early EAU, the photoreceptors preferentially utilize ·A-crystallin to suppress the mitochondrial oxidative mediated apoptosis Financial fundings: None Conflict of interest : None Keywords: uveitis, retina, alpha A crystallins
OP2-01 OCULAR MANIFESTATIONS IN CONGENITAL TOXOPLASMOSIS KODJIKIAN Laurent (Department of Ophthalmology, CroixRousse Hospital, Claude Bernard Lyon I University, Lyon, France), WALLON Martine (Dep a rtment of Pa ra s i t o l ogy, Croix-Rousse Hospital, Lyon, France), F L E U RY Jacques (Department of Ophthalmology, Croix-Rousse Hospital, Claude Bernard Lyon I University, Lyon, France), BINQUET Christine (Department of Biostatistics and Medical Informatics, Dijon, France), PEYRON François (Department of Parasitology, Croix-Rousse Hospital, Lyon, France), GARWEG G Justus (Department of Ophthalmology, Swiss Eye Institute, Bern, Switzerland) BACKGROUND: Retinochoroiditis is the most common ocular manifestation of congenital toxoplasmosis, but other associated ophthalmological pathologies can also occur. The aim of this study was to determine the nature of the latter in treated cases of the disease and to assess their impact on visual function. METHODS: Data from 430 consecutive children with serologically confirmed congenital toxoplasmosis were prospectively collected using standardized ophthalmological assessment forms. The presence of retinochoroiditis and of associated pathologies and their impact on visual function were assessed. RESULTS: After a median follow-up of 12 years [range 0.6-26 years], 130 children manifested retinochoroiditis. We detected 22
foci of retinochoroiditis at birth and 264 additional ones during the follow-up period. Of these, 48 (17%) were active when first diagnosed. Twenty-five of the 130 children (19%) had other associated ocular pathologies. Of these, 21 (16%) had a strabismus, which was due to macular lesions in 86% of the cases; 7 (5.4%) presented with unilateral microphthalmia, and 4 (3%) with cataracts. Most of these events were detected after the onset of retinochoroiditis. None of the children presented with ocular involvement in the absence of chorioretinal lesions. Visual impairment occurred in 31/130 cases, and in all but 3 of these eyes it was due not to an associated pathology but to macular retinochoroiditis. CONCLUSIONS: At the end of the follow-up period, ocular involvement existed in 30% of the treated children. Associated eye pathologies were manifested less frequently than anticipated. They may occur later in life and are an indirect marker of the severity of congenital toxoplasmosis, but they do not have a direct impact on visual acuity. The overall functional prognosis of congenital toxoplasmosis is better than would be expected on the basis of literature findings, with only 2 of the 130 children suffering bilateral visual impairment. Financial fundings: none Conflict of interest : none Key wo rds: C o n genital toxoplasmosis, re t i n o ch o roiditis, visual impairment
OP2-02 SECONDARY GLAUCOMA IN CHILDHOOD UVEITIS Heinz Carsten, Koch Jörg, Heiligenhaus Arnd (Dep a rtment of Ophthalmology at St.-Franzikus Hospital Muenster) Objective: Secondary glaucoma is a common and often challenging complication in uveitis, especially in children. In this paper we study glaucoma in juvenile uveitis with special reference to surgical methods and their limitations. Methods: Retrospective chart review of uveitic patients with secondary glaucoma. Results: Out of a total of 1997 uveitis patients seen during the time period of 1999 to 2006, 27 patients with uveitis occurring 16 years and with secondary glaucoma were identified. Eighteen (66%) had anterior uveitis, 6 (22%) intermediate and 3 (11%) panuveitis. Mean age at uveitis diagnosis was 5.8 SD 2.8 years. Time between diagnosis of uveitis and secondary glaucoma was 4.3 SD 3.5 years. Average topical glaucoma medication was 2.8 SD 1.0 drugs. Sixteen (59%) patients needed operative therapy. Overall 19 eyes were treated with cyclophotocoagulation and treatment had to be repeated at least once in 42%; overall success could only be achieved in 32 %. Filtering surgery was either performed as standard trabeculectomy with intraoperative MMC (TE) (16 eyes) or as a modified deep sclerectomy with trabeculotomy and MMC (mSR) (8). Both techniques significantly reduced the IOP compared to preoperative values (28.9 mmHg to 9.2 mmHg). Reduction of the topical glaucoma drugs was greater in the TE group. Overall success was achieved in 14 in the TE group, and in 6 patients after mSR. In the aphakic eyes, overall success was achieved in 2 of 3 eyes after TE, and 5 of 5 after mSR. Additional surgery and ocular hypotony was more frequent in the TE group. Conclusions: Secondary glaucoma in childhood uveitis generally requires multi-drug topical treatment, and surgery is often necessary. Cyclophotocoagulation is often unsuccessful, while good surgical results are obtained after MMC-trabeculectomy, or with mod-
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 44
Abstract Book ified deep sclerectomy in aphakic eyes. Financial fundings: (None.) Conflict of interest : (None.) Keywords: childhood uveitis, secondary glaucoma, treatment
OP2-03 BEHCET'S UVEITIS IN CHILDREN: CLINICAL COURSE AND VISUAL OUTCOME Kramer Michal1, Mukamel Masha2, Snir Moshe3, Friling Ronit3 1 Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel 2 (Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel 3Pediatric Ophthalmology Unit, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel Purpose: Behcet's disease is uncommon in childhood, when it may occasionally present in incomplete form. This study sought to characterize the clinical features and course of patients with Behcet's uveitis diagnosed before age 16 years. Patients and methods: The medical files of the Uveitis Clinic of Rabin Medical Center, and the Pediatric Ophthalmology Unit at Schneider Children?s Medical Center from 1997 to 2007 were reviewed for patients diagnosed with Behcet's uveitis before age 16 years, and the clinical data were collected. Results: Twelve patients, 8 male and 4 female, were identified. Mean age at onset of the ocular manifestations was 14 years (range, 9-16). Three patients had complete Behcet's disease and 9 had incomplete Behcet's disease with ocular involvement. Mean duration of follow-up was 5±3 years (range 1-10). The ocular involvement included panuveitis in 14 eyes (8 patients), posterior uveitis in 5 eyes (3 patients), and isolated anterior uveitis in 1 eye (1 patient). Mean number of acute ex a c e r b ations was 4±3 (ra n ge 1-8). Treatment included systemic steroids (11/12) and immunosuppressive agents (10/12) (multiple agents in 5 patients). Intravitreal triamcinolone injections was used repeatedly in 2 patients. Mean time to remission was 2.7±1.8 years (range 0.5-3). Mean initial visual acuity (VA) was 0.4±0.5 LogMar (range 0-2.2, 6/6-HM). Thirteen eyes (9 patients) had reduced VA (mean logMar 1.4±0.8) – severe in 8 (range 1/24 to LP, mean logMar1.9±0.4) during exacerbations. VA improved significantly at the last remission in 12 of 13 eyes (mean logMar 0.4±0.7; p= 0.0006), of whom 8 eyes (6 patients) had a VA of 6/7.5 or better. Conclusions: Behcet's uveitis in children is characterized by exacerbations with severely reduced visual acuity. Visual functions may be restored with aggressive immunosuppressive therapy. Therefore, appropriate diagnosis of even partial Behcet's disease is essential in this age group for timely administration of therapy. Financial fundings: none Conflict of interest : none Keywords: Behcet's disease, Uveitis, Children
OP2-04 UVEITIS IN CHILDHOOD : AN ITALIAN CLINICAL AND EPIDEMIOLOGIC STUDY Paroli Maria Pia, Liverani Marco, Spinucci Giovanni, Abdulaziz Randa, Pivetti Pezzi Paola (University of Rome "La Sapienza")
Introduction and Objective: to investigate demographics aspects and visual outcomes of children with uveitis Methods: Analysis of all clinical charts of patients referred from January 1995 to December 2004. The study included 257 consecutive patients <16 years old. Results: 54,5 % F and 45,5 % M. Uveitis accounted for 9,01 % of all endogenous uveitis. Median age was 8,54 years. Uveitis was anterior in 47,4%, intermediate in 19,8%, posterior in 24,5%. Panuveitis occurred in 7,8% of patients. Ocular involvement was bilateral in 67,8 % of patients and unilateral in 32,1%. Infectious uveitis rep resented 31% of all cases. Systemic disease we re observed in 27,8% of patients; a specific form of uveitis was observed in 27,6% patients.Two patients had a masquerade syndrome. The 12,8% of patients were classified as having idiophatic uveitis. The most frequent causes of severe visual loss were total cataract (25,6% of all eyes with VA<1/10),macular scars due to toxoplasma re t i n o ch o roiditis(16%) or other (9,6%),macular edema/maculopathy(16%) and secondary glaucoma (3,2%). At the end of FU time, 79,3% of eyes mantained a visual acuity (VA) between 6/10 and 10/10; 13,5 % of eyes had a VA between 2/10 and 5/10, whereas a lower percentage had a VA <1/10. Conclusions: Uveitis is rarer in children than in adults. Patients with anterior uveitis comprised the largest group. Posterior uveitis in the pediatric population have a lower incidence than some decades ago. Panuveitis comprised the less numerous group of patients (7,8%). The most common causes of uveitis in children were JRA-associated uveitis, pars planitis and toxoplasmosis. Idiophatic uveitis accounted for only 12,8%. Visual prognosis of pediatric uveitis is improving, owing to earlier diagnosis and correct treatment. Financial fundings: No Conflict of interest : No Keywords: Uveitis, childhood, visual prognosis
OP2-05 RISK FAC TORS FOR THE DEVELOPMENT OF SURGERY-REQUIRING CATARACT IN JUVENILE IDIOPATHIC ARTHRITIS-ASSOCIATED UVEITIS Sijssens Karen M. (FC Donders Institute of Ophthalmology, U n ive rsity Medical Center Utrecht, The Netherlands) Rothova Aniki (FC Donders Institute of Ophthalmology, University Medical Center Utrecht, The Netherlands) van de Vijver A.M.C. David (FC Donders Institute of Ophthalmology, Unive rsity Medical Center Utre ch t , The Netherlands) Stilma S. Jan (FC Donders Institute of Ophthalmology, University Medical Center Utrecht, The Netherlands) de Boer H. Jo ke (FC Donders Institute of Ophthalmology, University Medical Center Utrecht, The Netherlands) Introduction and objectives: The purpose of this study was to identify the possible risk factors for the development of surgeryrequiring cataract in children with juvenile idiopathic arthritis (JIA)-associated uveitis. Methods: In a retrospective cohort study the data of 53 children with JIA-associated uveitis of whom 27 with cataract extraction (CE) were obtained. The main outcome measure, time interval between the onset of uveitis and the first cataract extraction (time interval U-CE), was examined in relation to clinical and ophthalmologic characteristics and treatment strategies before cataract
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 45
Abstract Book extraction. Results: Children with posterior synechiae, children in whom the uveitis was the first manifestation of JIA and children treated with periocular corticosteroid injections had a shorter time interval UCE than those without posterior synechiae (hazard ratio: 3.57; 95% confidence interval: 1.33 to 10.00), those in whom arthritis was the first manifestation of JIA (hazard ratio: 1.59; 95% confidence interval: 0.63 to 4.00) and those not treated with periocular corticosteroid injections (hazard ratio: 3.23; 95% confidence interval: 0.95 to 11.11) respectively. Children treated with MTX had a longer time interval U-CE than children not treated with MTX (hazard ratio: 0.29; 95% confidence interval: 0.10 to 0.87). Conclusions: Risk factor for early cataract development in children with JIA-associated uveitis is the presence of posterior synechiae at time of diagnosis of uveitis. Uveitis being the first manifestation of JIA and treatment with periocular corticosteroid injections in the early phase of uveitis showed a trend towards early cataract development. The early treatment with MTX was associated with a mean delay in the development of cataract of 3.5 years. Financial fundings: K.M. Sijssens was supported by the Dr. F.P. Fischer Foundation, The Netherlands. D.A.M.C. van de Vijver was supported by the ViroLab-project which is sponsored by the European Union. Contract IST-027446. Conflict of interest : none Keywords: cataract, methotrexate, childhood
OP2-06 PATTERN OF CHILDHOOD-ONSET UVEITIS IN A REFERRAL CENTER IN TUNISIA, NORTH AFRICA. Messaoud Riadh (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia) Ghrissi Rim (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Thabti Akram (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Mnasri Heni (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Ben Yahia Salim (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia) K h a i rallah Moncef (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Introduction and objectives: To analyze the pattern of childhood uveitis in a referral center in Tunisia, North Africa. Methods: The study included 64 patients with uveitis examined at the Department of Ophthalmology of Monastir (Tunisia) from January 1994 to July 2005. All patients had a comprehensive ocular and systemic history, including an extensive review of medical systems. Complete ophthalmic examination was performed in all cases. Standard diagnostic criteria were employed for all syndromes or entities of uveitis. Results: The mean age at onset of uveitis was 12.4 years. The male-to-female ratio was 0.68. The process was unilateral in 51.6% of patients. Mean follow-up was 43.2 months. Anterior and intermediate uveitis each represented 31.25% of cases, posterior uveitis 20.3%, and panuveitis 17.2%. Noninfectious uveitis (75%) was the most frequent type of inflammation. Idiopathic uveitis was found in 50% of patients. Infectious uveitis was responsible for 25% of the cases, with toxoplasmosis (14.1%) being the most frequent cause. Twenty percent of the patients had systemic associations; juvenile idiopathic arthritis was found in 6.25%. Ocular complications occurred in 74.7% of affected eyes, of which the most common were posterior synechiae (28.4%), cataract (17.9%), cystoid macular edema (19%), and optic disc edema (32.6%). Fifty-seven affected eyes (60%) had a final visual acuity more than 20/40 and nine
(9.5%) had a final visual acuity less than 20/200. Conclusions: In a hospital population in Tunisia, a specific cause of uveitis in children was found in half the patients. Idiopathic intermediate uveitis was the leading cause of uveitis in our study, followed by idiopathic anterior uveitis and toxoplasmosis. Uveitis associated with juvenile idiopathic arthritis was rare. Visual prognosis appeared to be good. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Uveitis, Children, Tunisia
OP2-07 VALIDATION OF A STATISTICAL MODEL TO PREDICT SEVERE COURSE OF UVEITIS IN OLIGOARTICULAR JUVENILE IDIOPATHIC ARTHRITIS Elisabetta Zannin M (Department of Pediatrics, University of Padua, Italy) Buscain Irene (Department of Pediatrics, University of Padua, I t a ly) Cerm à kovà Ivet (Dep a rtment of Pe d i at ri c s , University of Padua, Italy) Cimaz Rolando (“A. Meyer” Hospital, Florence, Italy) Orsoni Yelka (Eye Clinic, University of Parma, Italy) Zulian Francesco (Department of Pediatrics, University of Padua, Italy) Background: It has been reported that that time interval between onset of arthritis and the first anterior uveitis and elevated a2-globulins level at onset of arthritis are predictors for severity course of anterior uveitis in oligoarticular Juvenile Idiopathic Arthritis (JIA). Objective: To validate the predictive model for severity of anterior uveitis in a multicenter prospective study. Methods: A cohort of patients from 12 pediatric rheumatology centers in Italy, with JIA-related uveitis diagnosed between 2001 and 2005 and at least one year follow-up, were included in the study. Information regarding number of uveitis relapses, ocular complications, a2-globulin level at the diagnosis of arthritis and treatment were prospectively collected. Results: 70 patients, 87.1% female, with mean age at the diagnosis of arthritis of 4.4 ± 3.4 years, entered the study. The mean followup after the diagnosis of uveitis was 2.8 ± 1.7 years. The mean number of relapses per patient was 2.7, with a highest value of 6 relapses per year. Twenty-three patients (32.9%) presented at least one complication during the follow-up. The statistical model for predicting the risk of severe uveitis, applied to 55 subjects with complete information, revealed 75.0% sensitivity, 42.9% specificity and 54.5% efficiency. Conclusions: This study confirms that, at the diagnosis of uveitis, the model is able to predict the development of a severe course in almost 8 out of 10 patients. The low specificity might be influenced by the short mean follow-up, lower than 3 years, and by the improved treatment options developed during the last few years. Financial fundings: (None.) Conflict of interest : (None.) Keywords: JIA, ANTERIOR UVEITIS, SEVERITY PREDICTORS, CHILDREN
OP2-08 OCULAR PROGNOSIS IN CHILDREN WITH CONGENITAL TOXOPLASMOSIS Garweg Justus G.(Swiss Eye Institute, Bern, Switzerland) Wallon Martine (Service de Parasitologie, Hôpital de la Croix-Rousse, Lyon, France ), Peyron François (Service de Parasitologie, Hôpital
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Abstract Book de la Croix-Rousse, Lyon, France Background and Methods: In an attempt to understand and interpret recent data on the effect of pre- and postnatal treatment, we tried to compare the data of our cohort of 430 children with CT to those published by other groups. 30.2% (130) of our patients developed OT lesions during a median follow up of 12 years comparing well to recently published data with ranges from 19-39% after follow up times of 1-4.5 years. Results: Only two children of our own series or 1.6% of all children showed a bilateral affection of their visual function. These results were achieved in our as well as in utmost of other recently published cohorts with a combination of in utero - and postpartal treatment throughout the first year of life and are markedly better than reported for historical cases who were untreated or treated for shorter periods. This view is also supported by the results of the SYROCOT meta-analysis which reports a weak evidence for an association between early prenatal treatment and reduced risk of congenital toxoplasmosis. Nevertheless, treatment efficacy is still a concern, since there is no obvious effect of antenatal treatment on the incidence of organ manifestations, and progression of e ye lesions may be observed in a number of eyes despite therapy during the first year of life. Conclusion: In the absence of controlled studies we have to assume that there exists a small but eventually relevant benefit of pre- and postnatal treatment. Although not all children do well with treatment, the outcomes of recently published cohorts indicate the importance of diagnosis and treatment of infants with congenital toxoplasmosis until the results of larger randomised controlled clinical trials provide valid evidence of the potential benefit of pre- and postnatal treatment. Financial fundings: None Conflict of interest : None Key wo rd s : Congenital Toxoplasmosis, Ocular Toxoplasmosis, Visual Function, Functional Outcome
OP2-09 CHARACTERISTICS OF CYTOMEGALOVIRUS ASSOCIATED ANTERIOR UVEITIS Chee Soon-Phaik (Singapore National Eye Centre and National University of Singapore), Jap Hee Eng Aliza (Singapore National Eye Centre) Introduction and objective s : Twenty-three percent of our patient?s eyes with hypertensive anterior uveitis were positive for Cytomegalovirus (CMV) of which 75% had Posner Schlossman Syndrome (PSS) and 21% had Fuch?s Uveitis Syndrome (FUS). We compared the characteristics of CMV positive and negative eyes in patients with these uveitides. Methods: Retrospective analysis of eyes with PSS or FUS for patient demographics, age at diagnosis, maximum re c o rd e d intraocular pressure, endothelial cell count, clinical appearance of the endothelium, pattern of keratic precipitates (kps), presence or absence of CMV in aqueous by polymerase chain reaction, Human immunodeficiency virus (HIV) status of CMV positive patients and presence of cataract and glaucoma. CMV positive and negative eyes were compared using univariate and multivariate analysis. Results: All the CMV positive patients were HIV negative. Of the 66 eyes with PSS, 34 were CMV positive. There was no difference between CMV positive and negative PSS eyes. There were 30 eyes of 29 patients with FUS, of which 10 were CMV positive. Older
age at diagnosis, re l at ive endothelial cell loss and abnormal endothelial appearance were significantly different on both univariate and multivariate analysis between CMV positive and negative FUS eyes. The endothelial abnormality seen was a small spot of translucent elevation of the endothelial surfa c e, i n t e rm i xed amongst the kps. Conclusions: There are no clinically detectable diffe rences between CMV positive and negative PSS eyes. CMV positive FUS patients are more likely to be older at diagnosis, have lower endothelial cell counts and endothelial abnormalities. Financial fundings: Nil Conflict of interest : Nil Keywords: Cytomegalovirus, anterior uveitis, immunocompetent
OP2-10 TWO CASES OF UVEITIS ASSOCIATED WITH THE SAPHO SYNDROME Sylvain Dreifuss (Clinique d'ophtalmologi e, Hôpitaux Unive rs i t a i re de Genève, G e n è ve, Suisse), C h ristine Fardeau (Service d'ophtalmologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France), Phuc LeHoang (Service d'ophtalmologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France) Introduction: SAPHO (referring to synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis) syndrome is characterised by the association of specific osteoarticular and dermatological manifestations. The disease is rare and of unknown origin. To our knowledge no ophthalmologic manifestations have been described previously. Method: We report two patients suffering from SAPHO syndrome who developed uveitis in the course of their disease. The first, a 57 year old female, had recurrent, unilateral, anterior, non-granulomatous uveitis which resolved with topical corticosteroids. The second patient, a 24 year old female, suffered from bilateral non-granulomatous anterior uveitis with chronic exacerbations and became dependant on low dose systemic and topical corticosteroids. In both cases, extensive systemic work-up did not reveal any infectious or auto-immune disease or systemic inflammatory disease except SAPHO syndrome. Discussion: Numerous arthropathies are associated with uveitis. Most frequently they are associated with HLA B-27 and the uveitis is generally anterior and non-granulomatous. Behcet’s disease, sarcoidosis and infectious diseases including tuberculosis, syphilis and Borreliosis also may present with dermatological and articular manifestations. In the two patients with uveitis presented here, only the SAPHO syndrome could be found after extensive work-ups. Conclusion: To our knowledge this is the first description of an association between the SAPHO syndrome and uveitis. This rare syndrome should be recognized as another arthropapthy predisposing to uveitis. Financial fundings: none Conflict of interest : none Keywords: SAPHO SYNDROME UVEITIS
OP2-11 BIOCOMPATIBILITY AND VISUAL OUTCOMES AFTER IMPLANTATION OF 1CU ACCOMODATIVE INTRAOCULAR LENS IN PATIENTS WITH FUCHS’ H E T E ROCROMIC IRIDOCYCLITIS A c c o rinti Massimo (Dipartimento di Scienze Oftalmologi ch e,
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Abstract Book Università di Roma "La Sapienza", Rome, Italy) Bruscolini Alice (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy) Bozzoni-Pantaleoni Fra n c e s c o (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy) Pirraglia Maria Pia (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy) Fabiani Claudia (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy) Pivetti-Pezzi Paola (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy) INTRODUCTION and OBJECTIVES: to evaluate the biocompatibility of acrylic 1CU accomodative intraocular lens (IOL) and study visual rehabilitation in young patients (pts) with unilateral cataract in Fuchs’ heterocromic iridocyclitis (FHI). METHODS: eleven pts (3F,8M) aged 18 to 40 y ears (mean 31.81±6.55 years) with unilateral FHI and complicated cataract underwent cataract surgery by phacoemulsification and 1CU accomodative IOL implantation. Biocompatibility, uncorrected and best corrected distance visual acuity (UDVA and BCDVA), uncorrected and best corrected near visual acuity (UNVA and BCNVA), stereopsis, accomodation and ocular complications were evaluated at 1, 6 and 12 months postoperatively RESULTS: d u ring fo l l ow-up inflammatory reaction did not change showing the same degree observed preoperatively. On month 1 and 6 the UDVA was ? 8/10 and BCDVA of 10/10 in 9 pts. Two patients showed BCDVA of 7/10 due to vitreal haze. On month 1 seven pts (63,6%) achieved an UNVA of J3 and 4 pts (36,4%) of J4 stable also on month 6; BCNVA were J2 in all patients (mean correction: 1.23 ± 0.52 diopters). On month 12 the UDVA and UNVA were unchanged in 8 pts (72.7%) while 3 pts (27.3%), developed a posterior capsule opacification and a progressive decrease of visual acuity requiring yag laser capsulotomy. Mean accomodation amplitude was 1.77±0.47 diopters (subjective near point) and mean decrease of anterior chamber depth evaluated by UBM was 0.6 ± 0.08 mm. A good stereopsis was achieved in all patients during the follow-up. CONCLUSIONS: The 1CU IOL implantation in young patients with unilateral complicated FHI showed a good biocompatibility at medium term and provided satisfying visual rehabilitation in term of near visual acuity, accommodation and stereopsis Financial fundings: None Conflict of interest : None Keywords: Fuchs' heterocromic iridocyclitis, cataract, accomodative intraocular lens
OP3-01 EXPRESSION OF SUPPRESSOR OF CYTOKINE SIGNALING IN PERIPHERAL BLOOD MONONUCLEAR CELLS OF PATIENTS WITH ACTIVE BEHCET’S DISEASE Hong Wang (Beijing Tongren Eye Center, Affiliate of Capital University of Medical Sciences, Beijing, P.R. China, 100730) yunx ia liu (Beijing Tongren Eye Center, Affiliate of Capital University of Medical Sciences, Beijing, P.R. China, 100730) Xiaoyan Peng (Beijing Tongren Eye Center, Affiliate of Capital University of Medical Sciences, Beijing, P.R. China, 100730) Objective: To investigate suppressor of cytokine signaling (SOCS) mRNA and protein expression on peripheral blood mononuclear cells (PBMC) in patients with active Behçet’s disease, and the role of SOCS in the pathogenesis of Behçet’s disease.
Methods: Blood samples were taken from 16 Behçet’s disease patients with active uveitis and 16 healthy individuals. IFN- , IL-2, and IL-4 in the serum were measured by enzyme-linke d immunosorbent assay?ELISA?. PBMC were subjected to analysis of SOCS mRNA and protein expression using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and western blot, respectively. Results: The level of IFN- , IL-2 and IL-4 are all significantly higher in the serum of patients than in controls. Compared to healthy volunteers, the expression of SOCS1 and SOCS5 are up-regulated markedly in PBMC of Behçet’s disease patients with active uveitis, while CIS and SOCS3 are significantly decreased.There’s no difference between the two groups in SOCS2 expression. Conclusion: Marked increased expression of SOCS1 and SOCS5, and significantly decreased expression of CIS and SOCS3 may play an important role in the pathogenesis of Behçet’s disease. Financial fundings: This research is supported by National Natural Science Foundation and Beijing Nature Science Foundation. Conflict of interest : no Keywords: Behcet's disease, SOCS,Th cell
OP3-02 ANTI-TNF-ALFA THERAPY IN SEVEN PATIENTS WITH BEHCET'S UVEITIS: ADVANTAGES AND CONTROVERSIAL ASPECTS Graziani Giovanna (Ophthalmology Unit- Padua UniversityItaly), Tognon Sofia (Ophthalmology Unit- Padua University- Italy) Introduction and objectives. Behçet’s disease (BD) is a chronic, relapsing, multisystem disease. In some patients, ocular involvement can lead to severe vision impairment despite immunosuppressive therapy. Since high levels of circulating TNF-alfa have been found both in peripheral blood and humour aqueous of patients with active BD, we evaluated the efficacy of anti TNF-alfa therapy in seven patients with severe ocular involvement resistant to previous treatment. Methods. Seven patients with sight-threatening relapsing uveitis re f ra c t o ry to immunosuppressive regimens received i. v. Infliximab, 3 or 5 mg/kg on week 0-2-4 and then every 6-8 weeks, in combination with low dose prednisone and methotrexate or azathioprine. Efficacy was assessed in terms of number and severity of posterior uveitis relapses, visual acuity and reduction of corticosteroids and immunosuppressive drug requirement. Results. After a mean follow-up of 26 months, the total number of relapses dropped to 6, compared to the 21 observed before. The visual acuity doesn?t worsened in any eye: particularly improved in 4 eyes while remained stable in the others 10 because previous irreversible lesions. Therapy with Infliximab considerably reduced the required daily dose of both corticosteroids and immunosuppressive drugs. Conclusions. In our experience Infliximab proved to be effective in controlling both the number and intensity of posterior uveitis and the extra-ocular manifestations of BD. It also allowed a reduction of corticosteroids and immunosuppressive drugs required to control the disease. However, ocular and systemic manifestations tended to recur after drug withdrawal or when the interval betwe e n Infliximab courses was longer than 8 weeks; moreover the risk of new evidence of multiple sclerosis during Infliximab treatment is confirmed in one of our patients. Infliximab administration is costly and requires hospital admission.
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Abstract Book Financial fundings: (None.) Conflict of interest : (None.) Keywords: Behçet’s disease, anti-TNF-alfa, Infliximab
OP3-03 OCULAR FEATURES OF BEHCET DISEASE: AN INTERNATIONAL COLLABORATIVE STUDY Kitaichi Nobuyoshi (Department of Ophthalmology and Visual Sciences, Hokkaido University Gra d u ate School of Medicine, Sapporo, Japan), Miyazaki Akiko (Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan), Stanford R Miles (St Thomas Hospital, London, UK), Chams Hormoz (Shariati Hospital, Teheran, Iran) Iwata Daiju (Department of Ophthalmology and Visual Sciences, Hokkaido University Gra d u ate School of Medicine, S ap p o ro, Japan), Ohno Shiegeaki (Department of Ophthalmology and Visual Sciences, Hokkaido University Gra d u ate School of Medicine, Sapporo, Japan) Objectives; The purpose of the present’study was to investigate the clinical features of ocular lesions in Behcet’s disease in different countries Methods; A descriptive questionnaire survey was performed of details of patients’ gender, age of disease onset, HLA-B51 positivity, extraocular lesions, type of intraocular inflammation and final visual acuity. Results; 25 eye centers in 14 countries of 132 invited to participate returned questionnaires on prevalent cases in 2006. Clinical data were analyzed on 1,465 patients with ocular lesions. 68.3% of the patients were men; average age of onset was 27.5?10.5 (3-71) years old. HLA-B51 was detected in 62.0% of the patients. Recurrent oral aphthous ulcers were reported in 94.5%, skin lesions in 69.5% and genital ulcers in 61.4%. Bilateral ocular lesions were seen in 85.5%. Recurrence of intraocular inflammation was seen in 95.7%. Combined anterior and posterior segment intraocular inflammation (CAPSII, panuveitis) was seen more in men (95.4%) than in women (89.9%, p<0.01). Three quarters of the patients had visual acuity equal to or better than 0.1 (20/200) at the final visit. The patients with poor vision were more frequently seen in India, Iran, and Japan than in other countries (p<0.01). Conclusions; We report the large contemporary international case series of patients with ocular involvement in Behcet?s disease. CAPSII/panuveitis was significantly more frequent in men than women and men tended to have a worse visual prognosis than women. There were some differences in the clinical pattern of Behcet’s disease in different countries. Despite modern treatment, the disease still carries a poor visual prognosis with one quarter of the patients blind (<20/200 bilaterally). Financial fundings: None Conflict of interest : None Keywords: Behcet's disease, ep i d e m i o l ogical survey, visual prognosis
OP3-04 LONG-TERM SAFETY AND EFFICACY OF INFLIXIMAB THERAPY IN REFRACTO RY UVEITIS DUE TO BEHÇET’S DISEASE Abu El-Asrar Ahmed M. (King Saud University), Abboud B. Emad (King Khaled Eye Specialist Hospital), Aldibhi Hassan (King Khaled Eye Specialist Hospital), Al-Arfaj Abdulrahman (King Saud University)
Purpose: To evaluate the long-term safety and efficacy of infliximab therapy for refractory uveitis associated with Behçet's disease (BD). Methods: We prospectively enrolled 6 patients who failed to respond to conventional immunosuppressive treatment. Infliximab infusions (5 mg/Kg) were administered at weeks 0, 2, 6, and then every 8 weeks. The outcome variables were visual acuity, control of inflammation, reduction of macular edema, tapering of immunosuppressive therapy, and adverse effects. Results: The follow-up period ranged from 27 to 46 months (mean ± SD, 34.2 ± 6.7 months). The number of infliximab infusions ranged from 16 to 29 (mean ± SD, 20.5 ± 4.4). By the 2-month follow-up, all patients had achieved remission, cystoid macular edema had re s o l ved and visual acuity had improved dra m atically. Throughout the follow-up period, 3 patients remained attack-free. One patient had one relapse, and another patient had 2 relapses before the scheduled infusions; all 3 relapses resolved rapidly after the subsequent infusion. One patient developed 5 relapses and infusions of 6-week intervals were necessary to achieve sustained remission. At the end of follow-up period, visual acuity improved in 5 patients. Concomitant immunosuppressive therapy was substantially reduced. Antinuclear antibodies developed and anti-double-stranded DNA antibodies developed in three patients. No major adverse effects requiring withdrawal of infliximab were observed. Conclusion: Infliximab is efficient and safe for long-term treatment of re f ractory uveitis associated with Behçet's disease. Repeated infusions are required to maintain long-term remission. Financial fundings: None Conflict of interest : None Keywords: anti-tumor necrosis factor-alpha antibody, Behçet's disease, uveitis
OP3-05 CLINICAL FEATURES OF CHINESE PATIENTS WITH BEHCET’S DISEASE Yang Peizeng (1State Key Lab o rat o ry of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Fang Wang (1State Key Lab o rat o ry of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Meng Qianli (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China) Ren Yalin (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China) Xing Lin (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Kijlstra Aize ( 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China; 3Eye Research Institute Maastricht, Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands)
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Abstract Book Objective: To characterize the clinical features of Behcet?s disease in Chinese patients. Methods: This retrospective study included 775 eyes of 437 patients with Behcet’s disease initially examined from August 1995 to June 2006. The history, demographical parameters and clinical findings of all consecutive Behcet’s patients referred to the uveitis study center of Sun Yat-sen University were reviewed. Laser flarecell photometry (LFCM), fundus fluorescein angiography (FFA), optical coherence tomography (OCT), ultrasound biomicroscopy (UBM) and B-scan ultrasonography were performed in certain cases. Most patients were treated by immunosuppressive agents combined with oral corticosteroids. Results: There were 319 male and 118 female patients. Panuveitis was the most common type of uveitis in both sexes although anterior uveitis was more frequently seen in females. Retinal vasculitis, vitritis and retinitis were the most common ocular manifestations in these patients. Cataract and macular edema were the most common complications. Oral aphthae were the most frequent extra-ocular manifestation, followed by dermatologic lesions and genital ulcers. The results of FFA, OCT, B-scan ultrasonography, LFCM and UBM were generally in accordance with or comparable with clinical observations. At the final visit, uveitis was well controlled in 86.2% of patients. However, 20.4% of eyes became legally blind despite of aggressive treatment. Kaplan-Meier analysis estimated the risk of losing useful vision (0.05) at 5 and 10 years for males and females as 29% vs 6% and 65% vs 33% respectively. Conclusions: Behcet?s disease in Chinese patients mainly manifests as non-granulomatous uveitis frequently associated with oral aphthae and dermatologic lesions. Auxillary examinatins may provide much information about pathophysiological hallmarks of Behcet’s disease. A combination of corticosteroids with other immunosuppressive agents is effective for most patients. Males have a more severe course and were at higher risk for losing vision than females. Financial fundings: This study was supported by the Fund for Innovative Research Groups of Guangdong province (05200176), Key Project of Natural Science Foundation (30630064), National supporting project of P.R. China and ‘5010’ Clinical Project of Sun Yat-sen University. Conflict of interest : None of the authors has a proprietary or financial interest in any product mentioned. Keywords: Behcet’s disease, Chinese, clinical features
China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Huang Xiangkun (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China) Kijlstra A i ze (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Objective: Behcet?s disease (BD) is a systemic inflammatory disease pre s u m ably caused by autoimmune response. IL-23/IL-17 pathway has been demonstrated to be involved in the development and maintenance of certain inflammatory diseases. The present study was designed to investigate the expression of IL-23 and IL-17 in BD patients and the effects of CsA on IL-23 and IL-17 in vitro and in vivo in BD patients. Methods: semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) was used for analyzing IL-23p19 mRNA level and ELISA for measuring the cytokines in the supernatants of cultured PBMCs. We used intracellular cytokine staining for IL-17 and IFN-Á and flow cytometry analysis for the expression of CD45RO and CD69. The influence of rIL-23 and rIL-12 on the production of IL-17 and IFN-Á were evaluated. The influence of CsA on expressioni of IL-17, IL-23, IFN-Á, CD45RO and CD69 were investigated in vitro and in vivo. Results: The results showed that the expression of IL-23 and IL-17 were markedly elevated in BD patients at both mRNA and protein levels. rIL-23 could up-regulate IL-17 production, while rIL-12 down-regulated IL-17 production. CsA could potently inhibit the expression of IL-23, IL-17 and IFN-Á in BD patients both in vitro and in vivo. However it did not influence the CD69 expression in CD4+ and CD8+ cells in vitro. Conclusions: Our findings suggest that IL-23/IL-17 pathway is actively involved in the development of BD and the inhibitory effect of CsA on uveitis is possibly, at least partially, through inhibiting the expression of IL-23, IL-17 and IFN-Á. Financial fundings: This study was supported by the Fund for Innovative Research Groups of Guangdong province (05200176), Key Project of Nat u ral Science Fo u n d ation (30630064) and International cooperation project of Guangdong prov i n c e (3030901005077). Conflict of interest :The authors have declared that no conflict of interest exists. Keywords: Behcet’s disease, IL-23, IL-17
OP3-06
OP3-07
INCREASED IL-23 AND IL-17 IN BEHCET’S DISEASE CAN BE INHIBITED BY CSA Yang Peizeng (1State Key Lab o ratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Chi Wei (1State Key Lab o rat o ry of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Zhu Xuefei (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Zhou Hongyan (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R.
UVEITIS IN CHILDREN WITH BEHCET’S DISEASE Kesen Muge R. (University of Illinois at Chicago), Goldstein A. Debra (University of Illinois at Chicago), Tessler H. Howard (University of Illinois at Chicago) OBJECTIVES: To describe the demographics, clinical presentation and visual outcome of uveitis in children with Behcet’s disease and to compare childhood-onset with adult-onset Behcet’s uveitis. METHODS: Retrospective review of patients referred to the Uveitis Service, University of Illinois at Chicago (UIC) from 1975 to 2007. RESULTS: 101 patients seen by the uveitis service at UIC between 1975 and 2006 met diagnostic criteria for Behcet’s Disease. 33 charts were available for review. 5 of 33 patients had childhood-onset Behcet’s uveitis and all were male. Among 28 patients with adult-onset uveitis, 7 were female (25%), 21 were
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Abstract Book male (75%). The mean follow-up period was 76.8 months for children and 51.4 months for adults. Mean age at onset of uveitis for children was 13 years and for adults 33 years. Mean age at BD diagnosis was 14 years for children and 35 years for adults. Oral ulcers were the most common initial symptom in both groups. More than 75% of both children and adults presented with panuveitis with retinal vasculitis/retinitis. All children were treated with immunosuppressive agents. 4 were treated with an alkylating agent for severe posterior segment involvement. 24 of 28 adults received steroid sparing agents, 18 were treated with alkylating agents. The most common ocular complications among ch i l d ren included increase in intraocular pressure/glaucoma (80%), cataract (80%), vascular occlusions (80%) and maculopathy (80%). Among adults most common were vascular occlusions (79%), cataract (57%), maculopathy (57%) and posterior synechiae (54%). CONCLUSIONS: Behcet’s uveitis has similar presentation in children and adults, with bilateral panuveitis and retinal vasculitis. There was an average delay of 1 year in children and 2 years in adults between onset of uveitis and BD diagnosis. Despite aggress ive tre atment complications were common and prognoses remained guarded. Financial fundings: None Conflict of interest : None Keywords: Behcet's Disease, uveitis, children
OP3-08 EFFICACY AND SAFETY OF INTERFERON ALPHA IN THE TREATMENT OF CORTICODEPENDENT UVEITIS OF PAEDIATRIC BEHÇET’S DISEASE Guillaume-Czitrom Seve rine (Bicetre Hospital), Berger Claire (Saint Etienne Hospital), Pajot Christine (Toulouse Hospital), Bodaghi Bahram (Pitie Salpetriere Hospital), Wechsler Bertrand (Pitie Salpetriere Hospital), Kone-Paut Isabelle (Bicetre Hospital) Objective: To report both the efficacy and safety of interferon alpha-2a (IFNa) therapy in corticodependent uveitis of paediatric Behçet’s disease (BD). Methods: Data from seven children affected with corticodependent uveitis of BD and treated with IFNa were reviewed retrospectively. IFNa was injected sub-cutaneously thrice a week at dosages of 1.5 to 3 Mons IU according to the children’s weight. Efficacy was judged on the ability of IFNa to induce a corticosteroid (CS)-sparing effect while maintaining remission. All adverse events (AE) were recorded. Results: The children included four boys and three girls. Mean age at onset of uveitis was 8.6 years, and mean follow-up duration was 7.14 years. All children had a high level of corticodependence, and five of them received additional DMARDs. A remarkable CS-sparing effect with remission maintenance was achieved in 5/7 patients after a mean period of 14.6 months of IFNa administration. The remission was sustained in four of the five patients (mean = 4.8 years), even after IFNa was discontinued in three of them. The other patient relapsed 1.5 years after IFNa discontinuation. The final two patients faced early severe adverse events attributed to IFNa: retinal venous thrombosis and major depression. Conclusion: IFNa has a potent CS-sparing effect in paediatric BD patients suffering from severe uveitis. However, the possibility of major side effects with this treatment calls for careful monitoring. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Interferon alpha, paediatric Behçet, uveitis
OP3-09 AN EVALUATION OF UVEITIS ATTACKS IN BEHCET’S SYNDROME Ozyazgan Yilmaz (University of Istanbul, Cerrahpasa Medical Faculty, Ophthalmology Department), Seyahi Emire (University of I s t a n bu l , Cerrahpasa Medical Faculty, R h e u m at o l ogy Department), Yazici Hasan (University of Istanbul, Cerrahpasa Medical Faculty, Rheumatology Department) Objective: We describe characteristics of attacks, which develop during the course of uveitis in patients with Behçet’s syndrome (BS). We also investigate the correlation of visual acuity loss with the place and severity of the inflammation. Methods: We surveyed consecutive 79 (58 M/ 21 F) patients with BS who had inflammatory eye attack. We determined a) the anatomical localization of the attack, b) the localization of the inflammatory infiltration –one of the important sign of attackbased on within or outside of the retinal vascular arcade and c) the severity score of the inflammation. Results: Twenty patients out of 79 had bilat e ral at t a cks. Among 99 eyes studied, at t a cks we re localized in the anterior uvea in 9, anterior + posterior uvea in 51 and only posterior uvea in the remaining 39. There were 5 eyes with hypopyon. Anterior chamber cells were present in 60 (cell 1+: 25; cell 2+: 24; cell 3+: 11) eyes and vitreous haze in 88 [mild: 24; moderate: 42; marked: 7; severe (preventing visualization of the retina): 15]. Excluding those with severe haze, exudates were in retinal vascular arcade in 22, outside in 30 and both in 9 eyes. Cystoid macular edema was found in 20 eyes. The decrease in non-permanent visual loss was correlated with the severity of the vitreous haze (r = 0.22, p = 0.03). The decrease in visual acuity was not different between those who had exudates within the vascular arcade as compared to those with exudates outside the vascular arcade (0.38 ± 0.36 vs 0.44 ± 0.33, respectively, p = 0.57). Visual acuity loss was negligible in the isolated anterior involvement. Conclusion: As expected vitreous haze seems to be associated with increased vision loss, however, vision loss was not statistically different between those who had exudates within or outside the vascular arcade. Financial fundings: None Conflict of interest : None Keywords: Behcet's syndrome, attacks, uveitis
OP4-01 EXUDATIVE AMD: ATTEMPT FOR PHENOTYPE-GENOTYPE CORRELATIONS BASED ON HTRA1 AND CFH POLYMORPHISMS. SOUIED Eric H(Hôpital Intercommunal de Créteil, Univ Paris 12), LEVEZIEL Nicolas (Hôpital Intercommunal de Créteil, Univ Paris 12), ZERBIB Jennifer (Hôpital Intercommunal de Créteil, Univ Paris 12), FREMEAUX BACCHI Veronique (HEGP Paris), SOUBRANE Gisèle (Hopital Intercommunal de Créteil, Univ Paris 12), BENLIAN Pascale (Hôpital Saint Antoine) Purpose: Major genetic susceptibility factors have been recently identified for atrophic and exudative age-related macular degeneration (AMD), including polymorphisms of CFH and HTRA1 genes. Exudative AMD is phenotypically heterogeneous and no phenotype-genotype correlation is clearly established to date. Our purpose was to analyze the angiographic features of patients with exudative AMD, homozygous for both high-risk genotypes.
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Abstract Book Methods: Genotyping consisted in analysis of Y402H CFH and rs4146894 HTRA1 polymorphisms. Three groups with different genotypes were established. Group 1 consisted in patients homozygous for rs10490924 polymorphism of HTRA1 and homozygous for wild type CFH. Group 2 consisted in patients homozygous for wild type HTRA1 and homozygous for Y402H polymorphism of CFH. Group 3 consisted in patients homozygous for both HTRA1 and CFH polymorphisms. Phenotype of exudative AMD was based on fluorescein angiography, infracyanin green angiography and optical coherence tomography. Results: Group 1 (n=10; mean age= 73.4) presented occult CNV (OCNV) in 1/10 (10%), minimally classic CNV (MC) in 1/10 (10%), classic or predominantly classic CNV (PC) in 7/10 (70%), and retinal anastomosis (RAP) in 1/10 (10%). Group 2 (n=11; mean age= 71.7) presented OCNV in 9/11 (82%), MC in 1/11 (9%) and PC in 1/11 (9%). Group 3 (n=12; mean age= 69.5) presented OCNV in 6/12 (50%), MC in 1/12 (8.3%), and PC in 5/12 (41.7%). Conclusions: Here we describe angiographic features in 3 small series of exudative AMD with distinct genotypes. Classic CNV were significantly more frequent in group 1 than group 2 (p<0.01).This attempt for phenotype-genotype correlations revealed an association between HTRA1 gene and classic CNV. Financial fundings: (None.) Conflict of interest : (None.) Keywords: AMD, choroidal neovascularization, genetics, CFH, HTRA1
OP4-02 HTRA1 AND PLEKHA1 POLYMORPHISM ASSOCIATED WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION IN THE FRENCH POPULATION BENLIAN Pascale (Faculté de Medecine Pierre et Marie Curie, INSERM UMRS538) LEVEZIEL Nicolas (Faculte de Medecine Pierre et Marie Curie, INSERM UMRS538), RICHARD Florence (INSERM UMR744, Institut Pasteur de Lille), ZOURDANI Alain (Creteil University Eye Clinic), SOUBRANE Gisele (Cre t e i l University Eye Clinic), SOUIED Eric (Creteil University Eye Clinic) Introduction and Objectives: Identification of genetic factors for age-related macular degeneration (AMD) is of crucial importance in this common cause of blindness. The exudative form of AMD is rapidly progressive and usually with severe prognosis. Common genetic variations on chromosome 10q26 were identified as risk factors for AMD. Our purpose was to investigate these variations in a case-control study, including French patients affected speicifically with exudative AMD. Methods: Sporadic AMD cases (n=180, age=73±4.9y) and sexmatched healthy controls (n=115, age=73.5±4.6y) were genotyped for: rs4146894:A>G at the PLEKHA1 gene and rs11200638:G>A within the HTRA1 gene promoter and rs10490924:G>T intergenic upstream of HTRA1. Results: The PLEKHA1 “A” allele was more prevalent (0.65) in exudative AMD cases than in controls (0.47; p=0.0001). After age/sex adjustment, compared to genotype GG, odds ratio (OR) for AMD were 4.3 [2.1-8.7, 95%CI, p=0.0001] and 2.0 [1.0-3.8, 95%CI, p=0.04] for AA and AG genotypes respective ly. Association was stronger at HTRA1 locus: rs10490924 “T” allele f re q u e n cy : 0.520 in cases vs 0.235 in contro l s , (p=0.0001). Compared to genotype GG, OR for the TT and GT genotypes were 18.3 [6.2-54.3, 95%CI, p=0.0001] and 2.8 [1.7-4.7, 95%CI, p=0.009] respectively. HTRA1 associated-variants were in high
linkage (97.7% allelic consistency). HTRA1 and PLEKHA1 were in linkage disequilibrium, with risk significance only for haplotypes involving SNPs at HTRA1 gene locus. Conclusions: HTRA1 gene contributed significantly to exudative AMD susceptibility in the French population. This finding may lead to early detection and new strategies for prevention and treatment of AMD. Financial fundings: Academic. Conflict of interest : None Keywords: Age-related Macular Degeneration, Single Nucleotide Polymorphism, HTRA1
OP4-03 DRUSEN OBSERVED IN CX3CR1 KNOCKOUT ANIMALS CONSIST OF LIPID BLOATED SUBRETINA L MICROGLIAL CELLS C.Feumi1A, F.Sennlaub1A, W.Raoul1A, M.Houssier1A, F.BeharCohen1A, C . C o m b a d i e re 1 B. AU598, BU543, 1Inserm, Pa ri s , France Purpose: Mutations in the CX3CR1 gene have recently been associated with human AMD. In Age related Macular Degneration, microglial cells acummu l ate subretinally. We here studied CX3CR1 expression in AMD sections and its influence on fundoscopic appearance and microglia in senescent mice and using CX3CR1 knockout and CX3CR1-KinGFP animals Methods: AMD sections, CX3CR1 -/-, CX3CR1 +/GFP and CX3CR1 GFP/GFP mice were used in this study. Fundoscopie, immunohistochemistry on flatmounts and sections and Electron microscopy (EM) was performed on these animals. Antibodies used were CX3CR1 and CD18 in AMD and GFP, 5D4, CD11, F4/80 and Rho4D2 on mice sections and flatmounts. Results: CX3CR1 is expressed in all retinal microglial cells in humans and mice (GFP staining in CX3CR1 +/GFP and CX3CR1 in humans). In AMD CX3CR1 positive bloated subretinal microglial cells are abundantly present. CX3CR1-/animals present a progressive accumulation of subretinal microglial cells (GFP, 5D4, F4/80, CD11b positive) with age. Senescent CX3CR1-/- animals show multiple ‘Drusen’ in fundoscopy. These ‘Drusen’are visible on RPE/choroidal flatmounts (after dissection of the retina). The anatomical equivalent of these ‘Drusen’ were identified as white bloated microglial cells with Rhodopsin positive intracellular inclusions. EM revealed important intracellular lipid accumulations and ROS remnants within subretinal microglial cells. Conclusions: Our data demonstrates important accumulation of SrMCs in senescent CX3CR1-/- animals. The resulting prolonged presence of MCs in the subretinal space leads to OS phagocytosis by SrMCs, and subsequent intracellular lipid accumulation in the SrMCs. Surprisingly, these subretinal microglial “foam cells” were at the origin of Drusen appearance in mice. Similarly, CX3CR1-positive bloated SrMC were found in AMD, suggesting that Drusen observed in AMD might in part be constituted of subretinal microglial “foam cells”.
OP4-05 PROTEOMIC PROFILING OF HUMAN RETINAL AND CHOROIDAL VASCULAR ENDOTHELIAL CELLS Smith Justine R (Casey Eye Institute, Oregon Health & Science University) David Larry (Biochemistry & Molecular Biology, Oregon Health & Science University), Zamora David (Casey Eye Institute, Oregon Health & Science University), Choi Dongseok
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Abstract Book (Public Health & Preventive Medicine, Oregon Health & Science University), Rosenbaum James (Casey Eye Institute, Orego n Health & Science University) Introduction: Common to leading causes of retinal blindness in Western nations is a key role for the endothelial cell (EC) in basic disease mechanisms. Choroidal ECs are the source of the neovascular nets that characterize exudative AMD, and retinal ECs participate in the initiation of diabetic retinopathy and posterior uveitis. We used a proteomics approach to compare protein preparations isolated from retinal and choroidal ECs, hypothesizing that ECs at these two sites would exhibit molecular diversity, with implications for disease-specific pathogenesis. Methods: Retinal and choroidal ECs were separately isolated from eyes of 5 human cadavers by collagenase II digestion followed by anti-CD31 antibody-conjugated magnetic bead separation. ECs were lysed by sonication in 2% SDS, and protein was precipitated with acetone. Retinal and choroidal samples from each donor were labeled with Cy3 and Cy5, respectively, and separated by 2-dimensional difference gel electrophoresis (2D-DIGE). Differentially abundant protein spots present in 4 of 5 donor gels were detected by the SAM method, with FDR set at 5%. Corresponding spots were excised from Coomassie-stained 2-dimensional electrophoretic gels. Protein identification was performed by liquid chromatography and tandem mass spectrometry (MS). Results: 31 of 123 protein spots detected by 2D-DIGE that qualified for statistical analysis were significantly differentially abundant in choroidal versus retinal EC samples. 17 proteins identified by tandem MS included 5 proteins involved in the regulation of angiogenesis, i.e., calreticulin and cathepsin B (more abundant in retinal endothelium) and glutathione peroxidase 1, ubiquitin carboxyl-terminal hydrolase isozyme L1 and superoxide dismutase [Cu-Zn] (more abundant in choroidal endothelium). Conclusions: Our data indicate that the proteomes of retinal and choroidal ECs are different and further suggest that angiogenesis within the retina, a component of severe diabetic retinopathy and posterior uveitis may be controlled by different mechanisms to those regulating choroidal neovascularization in exudative AMD. Financial fundings: NIH/NEI, RPB Conflict of interest : No conflict of interest Keywords: vascular endothelium, eye, proteomics
OP4-06 RESCUE THERAPY WITH HIGH DOSE OF SYSTEMIC STEROIDS AND MYCOPHENOLATE MOFETIL (CELLCEPT®) FOR JUXTA/SUBFOVEAL CHOROIDAL NEOVASCULARIZATION SECONDARY TO NON-INFECTIOUS UVEITIS Neri Piergiorgio, Mariotti Cesare, Mercanti Lucia, Giovannini Alfonso (Polytechnic University of Marche-Ancona, Italy) Introduction and objectives: Choroidal neova s c u l a rization (CNV) is a severe complication of uveitis, often leading to dramatic reduction of visual acuity. The aim of this study was to evaluate the safety and efficacy of high dose of systemic steroids (SS) associated with Mycophenolat e M o fetil (Cellcep t ® , MMF), for the control of CNV secondary to noni n fectious uveitis, unresponsive to traditional immu n e - s u p p ressants. Methods: The study design was: prospective, consecutive, noncomparative, i n t e rventional case series. Patients affected by
Juxta/Subfoveal CNV secondary to non-infectious uveitis, nonresponding to traditional immune-suppressants, have been considered. All patients stopped previous immune-suppressive drugs, and then received intravenous methylprednisolone at the dose of 1 g daily for 3 days, followed by prednisone at the dose of 1 mg/kg daily, coupled with MMF (1g twice/day). Tapering of steroids was carried out on individual basis. Demographics, best-corrected visual acuity (BCVA) and fluorescein angiography (FA) findings were evaluated. Visual gain and loss were defined as a getting better or worsening of 2 or more lines of BCVA, respectively. CNV size after treatment was classified as “increased” and “reduced” if increased or reduced of more than 200Ìm2, respectively. Results: Nine patients (12 eyes) have been enrolled. At base line, mean BCVA was 0,3± 0,17 Standard Deviation (SD). At one year, all eyes considered had a BCVA improvement (p<0,05); mean BCVA was 0,62± 0,21 SD. At 12 months, all eyes had a reduction of CNV size (p<0.05). An oral dose of prednisone <10mg/day was achieved in a median time of 4 months (range, 3–6 months). During the treatment, side effects were mild and transitory. Conclusions: The combination of high dose of SS and MMF was safe and effective in controlling CNV secondary to non-infectious uveitis. Prospective case-control trials are mandatory to validate the data of this study. Financial fundings: None Conflict of interest : None Keywords: Mycophenolate Mofetil, Choroidal Neovascularization, Systemic Steroids
OP4-07 PUNCTATE INNER CHOROIDOPATHY: SURVEY ANALYSIS OF 77 PERSONS AND NEW PERSPECTIVE ON CHOROIDAL NEOVASCULARIZATION AND SUBRETINAL FIBROSIS Do Diana V (The Wilmer Eye Institute, The Johns Hopkins University School of Medicine) Gerstenblith Adam (The Wilmer Eye Institute, The Johns Hopkins University School of Medicine), Thorne E Jennifer (The Wilmer Eye Institute, The Johns Hopkins University School of Medicine), Sobrin Lucia (Massachusetts Eye and Ear Infirmary, Harvard Medical School), Foster Stephen C (Massachusetts Eye Research and Surge ry Institute, Harva rd Medical School), Nguyen Dong Quan (The Wilmer Eye Institute, The Johns Hopkins University School of Medicine) PURPOSE: To evaluate the demographic and clinical features of punctate inner choroidopathy (PIC). METHODS: A survey was designed and posted on the website of the PIC Society (www.picworld.com). Persons diagnosed with PIC who were in contact with the Society were invited to participate. Seventy-seven persons with PIC completed the survey. The main outcome measureswere demographics, presenting symptoms, disease manifestations, treatment regimens, and ocular complications, with particular attention to choroidal neovascularization (CNV) and subretinal fibrosis (SRF). RESULTS: Of the 77 participants who completed the survey, 90% were women, 97% Caucasian, and 85% were myopic. Median age of participants was 30 years (range 15 to 55 years). The median duration of disease at the time of survey completion was 3 years (range <1 to14). Reported presenting symptoms of PIC included scotomata (91%), blurred vision (86%), photopsias (73%), floaters (69%), photophobia (69%), metamorphopsia (65%), and loss of peripheral vision (26%). Eighty-five percent reported unilateral
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Abstract Book scotomata initially. Thirty-two percent of participants reported waxing and waning symptoms before treatment. The majority of participants (86%) had received treatment, most commonly with systemic (60%) and/or intraocular corticosteroids (22%). Fourteen percent of participants reported tre atment with at least one immunosuppressive agent at some time during their disease. Sixtynine percent had been diagnosed with CNV and 56% with SRF in at least one eye. In 75% of respondents, the onset of CNV and in 79% the onset of SRF occurred less than one year after the presenting symptoms of PIC. CONCLUSIONS: In this survey of 77 persons with PIC, the majority of respondents were young Caucasian myopic women, who experienced unilateral scotoma and blurred vision as initial symptoms. The ocular complications CNV and SRF were present in the majority of participants in at least one eye and typically occurred within the first year of initial symptoms. Financial fundings: (None.) Conflict of interest : None Keywords: Punctate Inner Choroidopathy, Choroidal neovascularization
OP4-08 EFFICACY OF INTERFERON ALFA-2A IN THE TREATMENT OF CHRONIC CYSTOID MACULAR EDEMA IN NON-INFECTIOUS UVEITIS Deuter Christoph M. E. (Dep a rtment of Ophthalmology I, University of Tuebingen), Koetter Ina (Department of Internal Medicine II, Unive rsity of Tu eb i n ge n ) , Guenaydin Ilhan (Department of Internal Medicine II, University of Tuebingen), Zierhut Manfred (Department of Ophthalmology I, University of Tuebingen) Introduction and objective: Because conventional immunosuppressive treatment often fails to manage cystoid macular edema (CME) in uveitis, novel approaches are necessary. We evaluated the efficacy of interferon (IFN) alfa-2a as a treatment for chronic CME in non-infectious uveitis. Methods: We analyzed 26 eyes of 15 patients with CME (mean duration 64.6 months) due to intermediate or posterior uveitis. Ineffective pre-treatment consisted of at least systemic corticosteroids, acetazolamide and one immunosuppressive drug. IFN alfa2a was administered at an initial daily dose of 3-6 million IU. Afterwards it was tapered over six months and discontinued finally if possible. If CME relapsed IFN alfa-2a was reinstituted and tapered again in order to evaluate minimal maintenance dose. Efficacy of treatment was assessed by OCT. Results: IFN alfa-2a showed effective (= complete resorption of CME within four weeks, able to taper IFN) in 17 eyes (65.4%), partially effective (= incomplete resorption of CME, unable to taper IFN) in 5 eyes (19.2%) and not effective (= no response or recurrence of CME) in 4 eyes (15.4%). In 8 patients (15 eyes) IFN alfa2a was discontinued after six months in remission. One of these patients was lost to follow-up then. In the remaining 7 patients (13 eyes) IFN alfa-2a had to be reinstituted due to a relapse of CME. However, all 7 patients responded again. During a mean follow-up period of 23.1 months (4 patients 33-36 months, 3 patients 3-14 months) since restart, IFN alfa-2a could be tapered to maintenance doses between 3 million IU every third day and 1 million IU every tenth day without a recurrence. Conclusions: IFN alfa-2a is an effective treatment for chronic
CME in uveitis. Whether and when IFN alfa-2a can be stopped without further relapses is one of the questions which have to be answered in the future. Financial fundings: None Conflict of interest : None Keywords: cystoid macular edema, treatment, interferon alfa
OP4-09 ARE INTRAVITREAL TRIAMCINOLONE INJECTIONS A TREATMENT OF CHOICE FOR LONG LASTING MACULAR EDEMA SECONDARY TO UVEITIS REFRACTORY TO SYSTEMIC ANTI-INFLAMMATO RY AND/OR IMMUNOSUPPRESSIVE DRUGS ? : A CASE REPORT WITH 6 YEARS OF FOLLOW-UP Schultze Dﾃｶbold Claudia (CHU de Nantes), Weber Michel (CHU de Nantes) Introduction and objectives : Treatment of macular edema secondary to uveitis and refractory to systemic anti-inflammatory and/or immunosuppressive drugs is most often challenging. Methods : Case report of a patient with bilateral macular edema secondary to idiopathic intermediate uveitis and refractory to general steroids, periocular steroids and immunosuppressive drugs treated since 2001 with repeated intravitreal triamcinolone in both eyes. Results : Visual acuity, quality of life, OCT macular thickness, secondary effects and treatment will be reported during a follow-up of more than 6 years. Visual acuity and quality of life take a great benefit after the firsts injections. But in course of time and after several injections, irreversible visual acuity decline appears despite a normal OCT macular thickness. The reasons for such a visual decline will be discussed. Other therapeutic options for macular edema secondary to uveitis will be discussed taking into account litterature data. Conclusions : In consideration of our case report, we could ask us if repeated intravitreal triamcinolone injections are a good medical option for long lasting macular edema secondary to uveitis refractory to conventional treatments. Our data seems to fit the same mitigated results observed after repeated triamcinolone injections in macular edema secondary to others conditions such as diabetes or vein occlusion. Financial fundings: none Conflict of interest : none Keywords: MACULAR EDEMA, UVEITIS, INTRAVITREAL TRIAMCINOLONE
OP4-10 CHARACTERIZATION OF IL-17+ IRBP T CELLS IN EAU Kaplan Henry J, Shao Hui, Sun Deming (University of Louisville ) Purpose: To determine the role of IL-17+ T cells in the pathogenesis of EAU and determine the induction and expansion of this T cell subset during the development of autoimmune uveitis. Methods: Uveitis was induced either by immunization with IRBP peptide or by adoptive transfer of IRBP-specific T cells to EAUprone (B6 and and IL-17 of the Tﾃ。10RIII) mice. Intracellular expression of IFN- cells was assessed by flow cytometry. In addition, IL-17-producing T cell subset was examined among the eye infiltrating cells and disease severity was also observed after neutralizing IL-17 cytokines by intra-vitreal injection of anti-IL-17
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 54
Abstract Book mAbs. Results: IL-17+ T cells appeared in the inflamed eye during the early disease stage (d20 post-injection of IRBP specific T cells) and remained through the late phase of the disease (d50). IL-17+ T cells were readily observed circulating in the periphery of the EAU mice. A subset of autoreactive IRBP-specific CD8+ T cells derived from the spleen of in vivo Ag-primed mice expressed IL-17. IRBPspecific T cells preferentially expressed IL-17 when cultured in IL23-containing -expressing cells became dominant when the T cellsÁmedium, while IFN- were cultured with IL-2. Importantly, both expanded T cell populations were uveitogenic. IL-23 promoted the expansion of both antigen-specific ? and IL-6 acted‚and non-antigen-specific IL-17+ T cells, while TGF- only on non-antigen-specific IL-17+ T cells. The activation of autoreactive IL-17+ T cells was markedly increased in vivo by the mycobacterial component of CFA and pertussis toxin (PTX) and in vitro by the ligation of Tolllike receptors. Conclusion: IL-17+ autoreactive T cells can be readily detected in the periphery and in the inflamed eye during the development of EAU. While IL-17+ T cells contain both antigen-specific and nonspecific cells, only the antigen-specific IL-17+ T cells were uveitogenic. Financial fundings: NIH and Research to Prevent Blindness, Inc, NYC Conflict of interest : None Keywords: autoimmune uveitis, T cells, IL-17
OP5-01 PROTEASES IN OCULAR ALLERGY Leonardi Andrea University of Padua, Ophthalmology Unit Chronic ocular allergies are characterized by an intense and persistent infl a m m ation of eosinophils and Th2-type ly m p h o cy t e s , corneal complications and tissue remodeling. Many cytokines, chemokines, proteases, such as tryptase, chymase, and metalloproteases (MMPs) and their inhibitors have been found to be overexpressed in tears and tissues of patients affected by VKC, confirming the complexity of mechanisms involved in the pathogenesis of inflammatory cell infiltration. Tear presence of MMP-1, -3, -8, -9, -10, -13, TIMP-1 and TIMP-2 was evaluated by microarray in vernal keratoconjunctivitis (VKC) patients. Inactivation of the protease inhibitor, alpha-1 antitrypsin (AAT), by MMP-1 and MMP-9 was inve s t i gated in vitro. Distribution of MMP-1, -3, -9, -13 was evaluated by immunohistochemistry. By different methods, tear levels of several MMPs, and activity of MMP-1 and MMP-9 were significantly greater in VKC patients than in healthy subjects while TIMP expression is similar to controls. Conversely, the AAT activity is significantly lower in VKC samples compared to normal tears, and reduced by MMP in vitro. for MMPs immunostaining was significantly higher in VKC compared to normal conjunctiva. Expression of proteases and their inhibitors may play an important role in inducing cell infiltration, chronic inflammation and the structural changes seen in chronic ocular allergies. Financial fundings: MIUR (ex 60%) 4277 and 1488 University of Padova (A.Leonardi) Conflict of interest : none Keywords: allergic conjunctivitis, MMP, proteases
OP5-02 EVALUATION OF DRY EYE PATIENTS FOR ASSOCIATED MEDICAL CONDITIONS Akpek Esen K. (The Wilmer Eye Institute, Johns Hopkins Hospital) Purpose: To analyze the patient characteristics, and evaluate the associated medical conditions, particularly Sj?gren?s Syndrome (SS), in a cohort of patients with dry eye syndrome. Methods: Medical records of patients with a primary diagnosis of tear film insufficiency (ICD code 375.15) or keratoconjunctivitis sicca (ICD code 370.33) were reviewed retrospectively for the presence of an associated medical condition. Two hundred and twenty consecutive patients who had 2 or more visits to the Ocular Surface Diseases and Dry Eye Clinic, during a period of 2 years (1/2004 to 1/2006) were included. The data gathered were analyzed using a customized database software. Presence of an underlying medical condition, in particular SS, and the timing of diagnosis relative to that of dry eye syndrome was assessed. Results: The majority of the patients (75.91%) were female with a mean age of 58 years (22 to 91). A total of 57 (26%) patients had an associated rheumatic disease; the most common being primary SS (24 patients) and rheumatoid arthritis (25 patients). Of all the patients with primary SS, 33.3% carried a diagnosis at the time of presentation, 50% were diagnosed as a result of the initial evaluation and 16.7% went on to develop it during follow-up. An overwhelming majority of the patients with rheumatoid arthritis (96%) carried a diagnosis of rheumatoid arthritis at the time of presentation. Among patients with no evident rheumatic disease initially, the rate of occurrence of SS during follow-up was 4% per personyear. Conclusions: A s s o c i ated medical conditions are common in patients with dry eye syndrome. SS is widely underdiagnosed and should be the focus of diagnostic evaluation. Financial fundings: None Conflict of interest : None Keywords: Dry Eye, Systemic Disease, Sjogren's Syndrome
OP5-03 HLA EXPRESSION IN OCULAR CICATRICIAL PEMPHIGOÏD ROBERT Pierre-Yves (Ophthalmology, CHU Dupuytren, Limoges), AL YOUSSEF Abir (UMR 6101, Limoges), BEDANE Christophe (Dermatology, CHU Dupuytren, Limges), COGNE Michel (UMR 6101, Limoge s ) , ADENIS Jean-Paul (Ophthalmology, CHU Dupuytren, Limoges), DROUET Mireille (UMR 6101, Limoges) Background: HLA antigens have been linked to Ocular cicatricial pemphigoïd (OCP) in several clinical studies. In this disease, an antibody targets the hemidesmosome, inducing inflammation and fibrosis of the ocular surface. In order to highlight the role of HLA molecules, we studied the expression of HLA molecules by conjunctival cells, both in vitro and in vivo, and the changes in this expression under stimulation by INFg, TNFa and TGFb. Methods: HLA Expression tests were performed on a conjunctival cell line 1-5C-4 and a lymphoid cell linge LY92. The expression of HLA A,B,C, DR and DQ was achieved using monoclonal antibodies on cell cultures in vitro, and from conjunctival imprints of OCP patients in vivo. Results: The increase of HLA A, B, C and DR under INFg stimulation was even increased when adding TNFa. HLA DQ expression
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Abstract Book was not detected in vitro. In vivo, OCP patients show a decrease in HLA A, B, C and DR expression when compared to controls. Conclusions: The upregulation of HLA molecules under INFg and TNFa, and the down-regulation of HLA molecules in OCP highlights the role of inflammation in this disease. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Ocular cicarticial pemphigoïd, HLA, INF gamma, TNF alpha, TGF beta, conjunctival cells.
OP5-04 TREATING TEAR FILM INSTABILITY IN DRY EYE Goes Frank M (Goes Eye Centre, Antwerp, Belgium) Introduction and objectives: The tear film in a dry eye patient is unstable and incapable of maintaining the protective qualities that are intrinsic to its structure and function. Instability in one or more of the tear film layers causes rapid tear film break-up times. If the blink occurs after the TFBUT, epithelial cell damage that can lead to signs and symptoms of dry eye. As the epithelial cells become damaged, the surface of the eye is no longer as smooth, disrupting the desired gliding characteristic of the eyelids during a blink. Methods: Tear instability, decreased lubricity, and epithelial cell damage play a role in dry eye. Since the clinical features of dry eye can often have a domino effect, it is necessary to target the root of the problem, tear film instability. Results: The mechanism behind Systane®s tear film stabilizer ability may be related to the HP-Guar/borate polymer system within the formulation. Once on the eye, the HP-Guar/borate polymer system produced a matrix network so the active demulcents, propylene glycol and polyethylene glycol, are retained on the eye on the eye thus increasing lubricity between the lid and ocular epithelial surfaces. The surface active HP-Guar/borate system is able to help stabilize the tear film at the epithelial interfaces. The stabilization of the tear film following Systane® Lubricant Eye Drops continued use is also evident by the significant reduction in corneal staining. Conclusions: Systane lubricating eye drops significantly extends TBUT to help the tear to become more stable. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Tear film, dry eye, artificial tear
OP5-05 TOPICAL CYCLOSPORIN-A IN DRY EYE ASSOCIATED WITH CHRONIC GRAFT VERSUS HOST DISEASE Kurt Rengin A. (Ankara Unive rsity Faculty of Medicine D ep a rtment of Ophtalmology) Yalç›nda F. Nil fer (Ankara University Faculty of Medicine Department of Ophtalmology), Atilla Huban (Ankara University Faculty of Medicine Department of Ophtalmology), Soydan Ender (Ankara University Faculty of Medicine Department of Haematology) Introduction and objective s : To rev i ew the use of topical cyclosporin-A use in dry eye associated with chronic graft versus host disease after haematopoetic stem cell transplantion in patients with haematologic malignancies.
Methods: Sixteen eyes of eight patients which have been followed by haematology department because of chronic graft versus host disease are evaluated prospectively. All the patients were given 0.05% cyclosporin-A topically twice daily concurrently with artificial tears for six months. A baseline clinical examination was performed including Schirmer test, tear break-up time and corneal staining with fluorescein sodium. Patients were examined at 1st month, 3rd month and 6th month after beginning of topical cyclosporin-A. At each follow up visit, examination findings were recorded as well as subjective complaints. Subjective complaints, visual acuity, Schirmer test, tear break-up time and corneal staining findings at baseline were compared with those at follow-up visits. Results: There were significant differences in corneal staining comparing the baseline to 3rd month (p<0.01) and baseline to 6th month (p<0.05). There was also a significant difference between baseline and 3rd month in the subjective complaint scores (p<0.05). However, there were no significant differences in visual acuity, Schirmer test results and tear break-up time in follow-up visits compared to baseline. There were no serious adverse effects observed in this study. Conclusions: An improvement was observed in subjective complaint scores and corneal staining scores with topical cyclosporinA in dry eye associated with chronic graft versus host disease. Visual acuity, Schirmer test results and tear break-up time did not differ during follow-up period. Financial fundings: none Conflict of interest : none Keywords: cyclosporin-A, dry eye, graft versus host disease
OP5-06 THE PHENOL RED THREAD TEST: OPTIMIZATION OF THE PROCEDURE FOR DIAGNOSIS OF OCULAR DRYNESS IN SJÖGREN’S SYNDROME De Monchy Ivan (Department of Ophthalmology, Hopital de Bicetre, South Paris University), Mariette Xavier (Department of Rheumat o l ogy, Hopital de Bicetre, South Pa ris University), Baudouin Christophe (Department of Ophthalmology, Hopital des Quinze-Vingts, Paris), O ff ret Hervé (Dep a rtment of O p h t h a l m o l ogy, Hopital de Bicetre, South Paris University), L abetoulle Marc (Department of Ophthalmology, Hopital de Bicetre, South Paris University) Objectives: To optimize the phenol red thread test and to determine its cut-off value for diagnosis of dry eye syndrome. Material and methods: The PRT test was performed before (PRT1) and after (PRT2) the Schirmer I test in both eyes of 63 consecutive patients complaining of ocular dryness secondary to Sjogren's syndrome. The same procedure was applied to 31 healthy volunteers. The patient and the control groups were matched for age and gender (mean age; 56.5 and 52.7 respectively). Results: The ROC (Receiver Operating Characteristic) procedure showed that 12 mm was the best cut-off value for PRT test in usual conditions (PRT1) whereas 14 mm should be used as threshold when PRT was performed after drying out the tears (PRT2). In the latter conditions, sensitivity and specificity were respectively 0.62 and 0.90, i.e. higher than with PRT1 (0.49 and 0.84, respectively). Agreement between PRT2 and Schirmer I tests was highly significant considering that 79.8% of the subjects had similar qualitative results, i.e. normal or abnormal, with the two procedures (p < 1010). No patient described ocular discomfort during the PRT test procedures.
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Abstract Book Conclusion: Drying out the lachrymal meniscus before proceeding to PRT test provides both a highly sensitive and specific method for dry eye diagnosis, with qualitative results similar to those of Schirmer I test in about 80% of the subjects. Because PRT causes less discomfort and is quicker than Schirmer I, this test could be used more frequently in a daily practice for the screening of dry eye syndrome. Financial fundings: None Conflict of interest : None Keywords: Ocular dryness, Sjogren syndrome, diagnosis
OP5-07 NEW MANAGEMENT OF DRY EYE AND RELATED KERATOPATHIES IN OCULAR INFLAMMATIONS Mannucci Lorenzo (Dep a rtment of Ophthalmology ) , Boldrini Enrico (Opocrin S.p.A.), Falcone Giulia (Opocrin S.p.A.) Introduction and objectives: Dry eye and related keratopathies are very frequent in course of ocular inflammations. All marketed lachrymal substitutes are ineffective when mucous layer is altered, because none of them is really mucin-like. So, we studied the mucoadhesivity and the re-epithelisation properties of a new compound, the Arabinogalactan (AG). Methods: AG, a natural polysaccharide from the Larch tree, was tested in different experimental conditions. Rheostress RS 150 Viscosimeter® was employed for measuring the AG bioadhesion in vitro. Shimadzu RF-551 Fluorimeter® was used for evaluating the precorneal residence time of AG + fluorescein solution (FITC-AG) in rabbits. Besides we employed standardized methodologies for dry eye and corneal ulcer induction, treated later with AG 5% solution. At last, we made Schirmer test I, cell viability, and histological evaluations. Results: In spite of newtonian non-viscous behaviour (Ë = 1.6 mPa.s), precorneal residence of AG 5% solution was evident up to 60 minutes after instillation in rabbits. The re-epithelisation speed of rabbit ulcers was significantly more rapid with AG treatment in comparison to the controls; the histological evaluation of corneal wound showed an early stratification of the tissue. Conclusions The long residence time of AG 5% solution derives from its high mucoadhesive properties ( ¢ Ë / Ë 17.21) as compared with hyaluronic acid (¢ Ë / Ë 3.02). Moreover AG performed favorably in the re-epithelisation of experimental corneal ulcers, and in dry eye course. These preliminary data suggest an use of AG also in human subjects as artificial tear and as epithelial turnover promoter. In particular, AG should be recommended when mucous layer is altered, to restore the lachrymal film adhesion; in this conditions, a "mucoadesive" and "non-viscous" lachrymal substitute, rather than a so called "mucomimetic" substitute, is preferable. In immune dry eye, autologous serum is added to mentioned therapy (adaptive immunity). Financial fundings: (None.) Conflict of interest : (None.) Keywords: lachrymal substitutes, arabinogalactan, immune dry eye
OP5-08 LOTEPREDNOL ETABONATE EFFECTIVELY INDUCES GLUCOCORTICOID RECEPTOR INTERNALIZATION IN HUMAN OCULAR SURFACE EPITHELIUM Sheppard John D (Eastern Virginia Medical School and Virginia Eye Consultants), Sumadre Sandeep (Eastern Virginia Medical
School and the Thomas R Lee Center for Ocular Pharmacology), Lattanzio A Frank (Eastern Virginia Medical School and the Thomas R Lee Center for Ocular Pharmacology), Williams B Patricia (Eastern Virginia Medical School and the Thomas R Lee Center for Ocular Pharmacology), Jacko J Scoper V Stephen (Eastern Virginia Medical School and Virginia Eye Consultants) Introduction: Loteprednol etabonate (LE) is an ester steroid with an established safety and efficacy profi l e. Intern a l i z ation of the glucoc o rticoid receptor (GCR) is a useful biochemical marker for stero i d efficacy, rep o rting the cumu l at ive effects of surface binding affinity, penetration, intranu clear transport, and RNA transcription. Human ptery gium patients demonstrated effective GCR internalization. Methods: 7 patients with surgical nasal pterygium had biopsy specimens from both the un-inflamed conjunctival donor and the inflamed excision sites placed in 0.9% saline at 4ºC. All patients had been on at least 1 month of BID LE therapy prior to surgery. Tissues were dissected on frozen plates and manually homogenized in Tris-buffer at pH 7.2, and protease inhibitor cocktail III added before centrifugation. Cytosolic supernatant was decanted and frozen at -20ºC, then analyzed for GCR internalization by Western Blot analysis. Results: GC receptor migration was used as a marker to compare tissues. Internalization was expressed as the percent difference between the amount of cytosolic receptor of the normal conjunctival donor site and the inflamed nasal excision site. A consistent pattern of receptor expression was observed in conjunctival tissue. Blots incubated in secondary antibody alone did not show any bands. The number of receptors in the normal temporal donor conjunctiva remained fairly constant between sites and between individual patients. Conclusion: LE induces significant GCR internalization in both inflamed pterygium tissues, and un-inflamed ipsilateral donor conjunctival epithelial tissues. LE should be considered for pre-operative and post-operative management of pterygium. Financial fundings: Bausch & Lomb, Inc. and the Thomas R Lee Center for Ocular Pharmacology Conflict of interest : Dr. Sheppard Receives grant support and/or consultant and/or lecture fees from Alcon, Allergan Inc., Bausch & Lomb Inc., Isis Pharmaceuticals, Lumenis, Ophthalmic Mutual Insurance Company, Santen Inc., Inspire, and Vi s t a ko n Pharmaceuticals LLC. Keywords: loteprednol etabonate, ocular surface, pterygium
OP5-09 TEAR FLUID CONCENTRATION OF MMP-8 IN OCULAR ROSACEA BEFORE AND AFTER DOXYCYCLINE TREATMENT Osmo Kari, Marko Määttä, Sirje Peltonen, Marjatta Kari and K. Matti Saari Departments of Ophthalmology and Allergology, Unive rsity of Helsinki, Helsinki, and Dep a rtment of Ophthalmology, University of Turku, Turku, Finland Introduction and objectives: Matrix metalloproteinase 8 (MMP8; collagenase 2) levels and activation are elevated in many inflammatory conditions. We studied whether MMP-8 concentration and activation in tear fluid are increased also in ocular rosacea (OR), and if oral doxycycline treatment could rectify the situation. Methods: Tear fluid samples were collected from 22 healthy normal controls and from 22 patients with OR before and 4 and 8
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Abstract Book weeks after oral doxycycline treatment of the the OR patients. Patients' subjective symptoms were scored. MMP-8 concentrations in the tear fluid were assessed by immunofluorometric assay and the molecular forms and isoenzyme expression of MMP-8 were studied by Western immunoblotting. Results: The mean MMP-8 concentration was stat i s t i c a l ly signific a n t ly higher in OR (156.8±207.4 μg/ml) than in the normal subjects (53.5±66.7 μg/ml) (P=0.036), but decreased to 79.2±141.6 μg/ml and 53.6±75.2 μg/ml after 4 and 8 weeks doxycycline treatment, respective ly. The OR patients ex p e rienced stat i s t i c a l lysignificant relief of their subjective symptoms (P=0.0001) after the dox y cycline regimen. Both the normal and OR tear fluid contained 60-80 kDa highly- glycosylated polymorphonuclear leukocyte-type MMP-8 isofo rm in Western immu n o bl o t t i n g. MMP-8 activation was present in the OR samples, and it was inhibited by oral doxycycl i n e. Conclusions: MMP-8 concentration and activation degree in tear fluid are increased in OR, probably reflecting increased inflammatory activity. Doxycycline reduces these levels and activation of MMP-8, and relieves patients' subjective symptoms. Financial fundings: No Conflict of interest : No Keywords: Ocular rosacea, matrix metalloproteinase 8, tear fluid
OP5-10 TOPICAL ADMINISTRATION OF AZITHROMYCIN FOR THE TREATMENT OF ACTIVE TRACHOMA Pablo Goldschmidt1, Mamadou Sow2, André Goepogui3, André Goepogui3, Isabelle Cochereau5 and Christine Chaumeil1 1 Laboratoire du Centre National d’Ophtalmologie des QuinzeVingts, Pa ris France; 2 Hôpital de Kankan-Haute-Guinea, 3 Hôpital Donka de Conakry, Guinea, 4 Al-Shifa Eye Hospital Rawalpindi, Pakistan and 5 CHU d’Angers, France. Background/aims: In trachoma, WHO recommendations consist in a single oral dose of azithromycin. The aim of this work was to s t u dy the effi c a cy and safety of a new topical solution of azithromycine 1.5%, to treat active trachoma compared to oral azithromycin. Methods: A ra n d o m i s e d, controlled, doubl e - m a s ke d, doubledummy, non-inferiority study conducted in Guinea Conakry and in Pakistan included 670 children [1-10 years] with active trachoma according the WHO grading scale. Children were randomly divided in three groups receiving either azithromycin 1.5% eye drops twice daily for two days, twice daily for three days, or azithromycin single oral dose (20 mg/kg). Clinical evaluation was performed by ophthalmologists using a binocular 2.5 X magnifying loupe. Primary efficacy variable was the negativation of clinical signs defining active trachoma (cure) at Day 60. Non-inferiority margin for cure rate difference between groups was 10%. Results: Cure rate in per-protocol set was of 93.0%, 96.3%, and 96.6% in the 2x2-day group, 2x3-day group, and oral treatment group respectively. The azithromycin 1.5% groups were non-inferior to oral azithromycin. Ocular tolerance was similar for all groups with no treatment related adverse events reported. This study shows higher levels of clinical responses than those reported previously and it should be stressed that every child and his family were sensitized on the need to present with clean face. On the above it can be hypothesised that the administration of efficacious antibiotic treatments directly on the organ where the blinding illness evolves may help to change the perception of the risk of a quasi silent blinding infection an to have a positive impact on the
children’s hygiene leading to the increase of antitrachoma therapeutic clinical responses. Conclusions: Azithromycin eye drops (2/d x 3d) are well tolerated in children with active trachoma and are as effective as the oral reference treatment.
OP5-11 THE EFFECTS OF CONJUNCTIVAL INJECTION WITH NKT CELLS ON INHIBITING RAT CORNEAL TRANSPLANTATION REJECTION Pan Zhiqiang (Beijing TongRen Eye Bank, Beijing TongRen Eye Centre, Beijing TongRen Hospital, Capital Medical University), Liu Ying (Beijing TongRen Eye Bank, Beijing TongRen Eye Centre, Beijing TongRen Hospital, Capital Medical University), Jie Ying (Beijing Insititute of Ophthalmology, Beijing TongRen Eye Centre, Beijing TongRen Hospital, Capital Medical University) Objective: To explore the effects of conjunctival injection with NKT cells on inhibiting corneal transplantation immune rejection in rat model. Methods: The lymphocytes were taken from the spleen of the Lewis rats and cultured in RPMI1640 medium. After three weeks, NKT cells were sorted by the FACSVantage system as CD161+ TCR-·+ cell from the lymphocytes. For corneal transplantation, Fisher344 rats were used as donors and Lewis rats as recipients. The recipient rats were divided into two groups. One was conjunctival injected with 0.1ml NKT cells at concentration of 5?104/ml at the end of keratoplasty. The group control received saline buffer of the same volume. All allografts were observed and scored for thirty days. Ten days after surgery, two rats in each group were sacrificed for histopathological and immunological evaluation. Results: The mean survival time of the allografts was 8.00±1.58d in the group control while 26.00±1.34d in the group treatment. Ten days after surgery, all the allografts were rejected in the group control with severe opacity and edema. But in the group treatment, almost all the allografts were not rejected, but with slight opacity and edema. There were abundant CD4+ and CD8+ lymphocytes infiltration in the allografts of the gr oup control, but significant reduction in the group treatment. The percentage of NKT cells in the spleen was ?3.90±0.32?? in the ex p e riment group, while?1.85±0.21?? in the control group. The percentage of NKT cells in the blood was?1.34±0.12?? in the experiment group, while ?3.59±0.23?? in the control group. Conclusions: Conjunctival injection with NKT cells could prolong the allografts survival in corneal transplantation, which suggested a potential therapy method for treating high-risk corneal transplantation. Financial fundings: National Natural Science Foundation of China. Project NO: 30271385 and Program for New Century Excellent Talents in University ‘NCET’. Conflict of interest : No Keywords: NKT cells. Corneal transplantation. Cells treatment
OP5-12 TRANSDUCED DENDRITIC CELLS: AN OPTION TO MODULATE CORNEAL ALLOGRAFT REJECTION ? No (Department of Ophthalmology, Charité – University Medicine Berlin, Germany) Department of Ophthalmology, Union Hospital, Tongji Medical College***, Huazhong University of Science and Technology, China
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 58
Abstract Book Lie Sch l i ckeiser Stephan Q (Department of Ophthalmology, Charité – University Medicine Berlin, Germany, Sawitzki (Institute of Immunology, Charité – University Medicine Berlin, Germany), Ritter Thomas (Regenerative Medicine Institute****, National University of Ireland, Galway, Ireland) Introduction: Recent strategies to induce donor-specific tolerance focus on regulatory dendritic cells (DC). Adenoviral expression of immunosuppressive molecules is an attractive approach to enhance their tolerogenic potential. Methods: In this study, we compared the immunoregulatory properties of CTLA4?Ig and vIL?10 secreting DC in vitro and in vivo, in a high responder corneal transplantation model (BALB/c; H-2d into C57BL/6; H-2b). Results: Transduction of DC with AdCTLA4-Ig prior to LPS stimulation dramatically diminished their allostimulatory capacity in vitro, as demonstrated by an inhibition of proliferation of cocultured allogeneic T cells. Compared to controls, AdvIL-10 transduced DC showed a significant decrease in their ability to activate T cells. Whereas adoptive transfer of CTLA4-Ig transduced DC could not prolong graft survival vIL-10 expressing DC significantly reduced the rejection rate of corneal allografts compared to control cells. Prolonged graft survival was associated with significantly higher levels of splenic Foxp3+CD25+CD4+ regulatory T cells in animals which received vIL-10 transduced DC in comparison to those receiving AdEGFP transduced control DC. Conclusions: Genetic modification of dendritic-cell function could to be an attractive approach to modulate corneal graft rejection. Financial fundings: (Supported in part by DFG Pl 150-14/2) Conflict of interest : NONE Keywords: keratoplasty, gene therapy, dendritic cells
OP5-13 CD4+CD25+ REGULATORY T CELLS INVOLVE IN RAT CORNEAL TRANSPALNTATION TOLERANCE INDUCTION Xi Jin (Beijing United Family Hospital) Pan Zhiqiang (Beijing Tong Ren Hoapital), Jie Ying (Beijing Tong Ren Hoapital), Liu Limin (Beijing Tong Ren Hoapital), Wang Li (Beijing Tong Ren Hoapital) I n t roduction and objective s : To observe the ex p ression of CD4+CD25+ regulatory T cells (Tregs) in the high risk rat corneal transplant tolerance induced by Staphylococcal enterotoxin B (SEB). Methods: A high risk rat penetrating corneal transplantation model was established. SD donor corneas were implanted into Wistar recipients. The recipient rats were divided into two groups. Group control had intraperitoneal injection of 0.2ml saline while SEB group received 0.2 ml SEB (75 μg/ml) every 4 days and repeated for 3 times. Orthotropic corneal transplantation was performed 1 day after the last injection. The corneal graft survival time was evaluated. The expression of CD4+CD25+ Tregs in corneal grafts and iris was evaluated by immunohistochemical staining 0, 10 and 3 0 d ays postoperative ly. Pe rc e n t age of CD4+CD25+ Tregs in peripheral blood was determined by flow cytometry at 0, 10, 20 and 30 days postoperatively. Results: The corneal graft mean survival time in group SEB was significantly longer than in group control. Immunohistochemical staining of grafts showed the CD4+CD25+ Tregs were expressed in rejected grafts in both groups 10 and 30 days postoperatively.
Wholemount staining of the iris showed before corneal transplantation, no expression of CD4+CD25+ Tregs was observed in group control while relatively remarkable expression in group SEB. 10 days operatively, CD4+CD25+ Tregs were observed in both groups while group SEB showed more pronounced staining. 30 days postoperatively, CD4+CD25+ Tregs were also noticed but with milder staining in both groups. Peripheral blood flow cytometric analysis revealed the mean percentages of CD4+CD25+ Tregs in group SEB was significantly higher than that in group control within 11 days after the last SEB injection. Conclusions: The high expression of CD4+CD25+ Tregs might suggest they take part in immune tolerance in high risk rat corneal transplantation induced by SEB. Financial fundings: none Conflict of interest : none Keywords: regulatory T cells, immune tolerance, high risk corneal transplantation
OP5-14 GITR-LIGAND-INDUCED REGULATORY T CELLS AS A MECHANISM OF IMMUNE PRIVILEGE OF CORNEAL ALLOGRAFTS Hori Junko (Nippon Medical School), Taniguchi Hiroko (Nippon Medical Sch o o l ) , Wang Mingcong (Nippon Medical Schoo), Oshima Masamichi (National Institute of Infectious Disease), Azuma Miyuki (Tokyo Medical and Dental University), Sakaguchi Shimon (Kyoto University) Purpose: The pat h way between glucocorticoid-induced TNF receptor family-related protein (GITR) and its ligand (GITRL) has been shown to control the function of regulatory T cells (Treg). The purpose of the present study was to determine whether Treg are involved in immune privilege in corneal transplants, and if so, to elucidate the role of GITR-GITRL signaling in corneal transplants. Methods: Normal corneas of C57BL/6 mice were orthotopically transplanted into normal eyes of BALB/c mice, and graft survival was assessed. In a separate experiment, BALB/c mice received anterior chamber injection of C57BL/6 splenocytes 2 weeks prior to subcutaneous immunization. Induction of allo-specific anterior chamber-associated immune deviation (ACAID) was assessed by ear challenge with C57BL/6 splenocytes at 1 week after immunization. Recipients were intraperitoneally administrated agonistic antiGITR (DTA-1) or antagonistic anti-GITRL (MIH44) mAbs, or control IgG, for 8 weeks after corneal grafting, and for 3 weeks after AC injection. Expressions of GITRL, GITR, and Treg-specific transcription factor Foxp3 in normal and graft-bearing eyes were assessed. Results: GITRL was ex p ressed constitutive ly in the corn e a l endothelium, iris-ciliary body and RPE. Treatment with DTA-1 or MIH44 did not affect allo-specific ACAID, but led to accelerated corneal allograft rejection. GITRL-expressing corneal allografts were infiltrated with a small number of Foxp3+GITR+CD25+CD4+T cells, during which allograft acceptance occurred. The proportion of Foxp3+GITR+CD25+CD4+ T cells was increased in the spleen of these recipients. In contrast, blockade of GITRL, or artificial stimulation of GITR by agonistic antibody, led to infiltration of a number of Foxp3(-)CD4(+) T cells into allografts, leading to allograft rejection. Conclusions: T cell stimulation through GITR by agonistic mAb enhances effector T cell responses against corneal allografts. Conve rs e ly, GITRL expressed on corneal endothelium plays a role in the acceptance of
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Abstract Book corneal allogra f t s , via Treg - m e d i ated suppression within the cornea. Financial fundings: none Conflict of interest : none Keywords: Immune privilege, T reg, corneal allografts
OP6-01 CLINICAL AND OPTICAL COHERENCE TOMOGRAPHIC FINDINGS AND OUTCOME OF TREATMENT IN PATIENTS WITH PRESUMED TUBERCULOUS UVEITIS Abu El-Asrar Ahmed M. (King Saud University), Al-Mezaine Hani (King Saud University), Kangave Dustan (King Saud University) Purpose: To define clinical characteristics and optical coherence tomographic (OCT) features and to assess outcome of treatment in patients with presumed tuberculous uveitis (PTU). Methods: All patients diagnosed with PTU at King Abdulaziz Unive rsity Hospital between 1998 and 2006 we re rev i ewe d. Diagnosis was made when findings were consistent with possible intraocular tuberculosis with no other cause of uveitis suggested by history, symptoms, or ancillary testing, strongly positive tuberculin skin test results and response to antituberculous therapy. Results: Fifty-one patients (73 eyes) were identified. There were 34 (66.7%) males and 17 (33.3%) females with a mean age of 40.1 ± 11.0 years. Fifty-eight (79.5%) eyes had panuveitis, and 15 (20.5%) eyes had posterior uveitis at presentation. Clinical manifestations included vitritis (71.2%), macular edema (63%), retinal periphlebitis (35.6%), multifocal choroiditis (20.5%) and granulomatous anterior uveitis (17.9%). All patients received antituberculous therapy and systemic corticosteroids. After a mean follow-up of 18.9 ± 21.9 months (range, 6 to 96 months), all eyes showed resolution of inflammation with no recurrences associated with significant improvement in visual acuity (VA) (p = 0.007). There was a significant positive correlation between initial and final VAs (r = 0.7856, p<0.001). Thirty-one eyes with macular edema were examined at baseline and at follow-up with OCT. There were 3 patterns of macular edema: diffuse (DME) (28.5%), cystoid (29%) and serous retinal detachment (45.2%). Initial VA of 20/40 or better was significantly associated with central macular thickness m or less (p=0.0065), and DME (0.0484). At finalÌ(CMT) of 300 follow-up, there was a significant reduction in CMT (p<0.001) associated with a significant improvement in VA (p=0.0091). Conclusions: Antituberculous therapy combined with systemic corticosteroids leads to resolution of inflammation and elimination of recurrences in PTU. OCT is useful in monitoring the efficacy of treatment in patients with macular edema. Financial fundings: N/A Conflict of interest : N/A Keywords: uveitis, tuberculosis, optical coherence tomography
OP6-02 FLUORESCEIN AND INDOCYANINE GREEN A N G I OGRAPHIC AND TOMOGRAPHIC FINDINGS IN PRIMARY INTRAOCULAR LYMPHOMA Lee Cheryl PL (Bristol Eye Hospital, Bristol), Fardeau Christine (Department of Ophthalmology, P i t i é - S a l p é t ri è re Hospital, University Paris VI, Paris), Cassoux Nathalie (Department of Ophthalmology, Pitié-Salpétrière Hospital, University Paris VI, Paris), Merle-Béral Hélène (Cytology Laboratory, Pitié-Salpétrière
Hospital, Unive rsity Paris VI, Paris), Bodaghi Bahra m (Dep a rtment of Ophthalmology, Pitié-Salpétrière Hospital, U n iversity Pa ris VI, Pa ri s ) , LeHoang Phuc (Dep a rtment of Ophthalmology, Pitié-Salpétrière Hospital, University Paris VI, Paris) Primary non Hodgin?s oculo-cerebral lymphoma has a mean diagnostic delay of 20 months after the initial mainly ophthalmological symptoms. The vital prognosis is threatened through cerebral involvement present in half of cases at time of diagnosis. The goal of this study was to identify indicative angiographic and tomographic features of this disease. Patients and method : From 1st January 1999 to 18th November 2005, the patients who underwent diagnostic vitrectomy had had fluorescein angiography which was associated for most of them to indocyanine green angiography and optical coherence tomography b e fo re surgical time. Vitreous samplings were analysed by immunocytochemistry associated to immunoglobulin genes amplification when necessary. Retinal angiography and optical coherence tomography were retrospectively reviewed without knowing the final diagnosis. Results : Of two hundred fifty vitreous samplings analy s e d, 53 cases of lymphoma we re diag n o s e d. In fl u o rescein angi ograp hy nu m e rous small round hy p o fl u o rescent lesions visible at early and l ate phase, corresponding to white punctuate lesions seen in red free p h o t ograp hy we re statistically more frequent in the patients with lymphoma (p<0.001). In these patients indocyanine green angi ograp hy showed scarce small hy p o fl u o rescent lesions. This angi ograp hic pat t e rn was associated to multiple nodular hy p e rre fl exive lesions seen at pigment epithelium level in optical coherence tomograp hy. Stat i s t i c a l ly this angi ographic and tomographic pat t e rn ap p e a re d highly suggestive of intraocular lymphoma diagnosis. Conclusion : Retinal angiography and tomography usually performed in posterior chronic uveitis could show indicative signs that could lead more quickly in obtaining biopsies for cytologic, immunocytochemistry, molecular exams. This procedure could help to achieve earlier a suitable treatment. Financial fundings: none Conflict of interest : none Keywords: retinal angiography, primary ocular lymphoma, optical coherence tomography
OP6-03 OCULAR BLOOD FLOW IN HEPATOESPLENIC FORM OF SCHISTOSSOMIASIS MANSONI Souza Ana Catarina Delgado de(Clinica Oftalmologica Zona Sul e Unive rsidade Fe d e ral de Pern a m bu c o ) , Just Eduardo ( U n ive rsidade Fe d e ral de Pernambuco), Ve n t u ra Cab ral de C at a rina (Fundaçao Altino Ventura), B randt Te i xe i ra Carlos (Universidade Federal de Pernambuco) Objective: To investigate blood flow velocities and resistance index of retrobulbar vessels from patients bearers of mansonic schistosomiasis in its hepatosplenic form who underwent splenectomy, ligature of left gastric vein and auto-implantation of spleen morsels into major omentum (group I) and similar patients who had not undergone surgery (group II). The parameters of blood flow were compared with control group of health volunteers (group III). Methods: Using color dopplerfluxometry the following parameters were measured: peak systolic, end diastolic and medium velocities, and resistance index of the superior ophthalmic artery (OA), and
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Abstract Book the central retina artery (CRA); and also the minimal, medium and maximum velocities of the retina central vein (RCV) from 23 patients of group I, 15 of group II, and 22 volunteers of group III. Ophthalmologic findings were reported from all participants. Results: Maximum, minimal and medium blood flow velocities of the RCV were significantly greater in eyes of group II when compared with group III. There was a trend of increasing the maximum systolic velocity and final diastolic velocity of CRA also in group II when compared with group III. These results were more evident in right eye. All other parameters were similar among the three groups. There was association between increased blood flow velocity and presence of tortuous and increased diameter vessels found in fundoscopy. Conclusions: Ocular dopplerfl u x o m e t ry findings in group II showed greater blood flow velocities of CRA and CRV when compared with healthy people. Besides, it was significantly associated with tortuous and increased diameter vessels found in fundoscopy. These increased blood flow velocities in CRA and CRV, not described before, can be associated to an inflammatory process of immune etiology and open new perspectives to future investigations. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Schistosomiasis mansoni, Dopplerfluxometry, Eye
OP6-04 OCULAR TOXOPLASMOSIS: AN OPTICAL COHERENCE TOMOGRAPHY STUDY Belfort Jr Rubens, Andrade E Rafael, Muccioli Cristina, Farah E Michel, Silveira Claudio (Instituto da Vis達o, IPEPO, Department of Ophthalmology, Federal University of S達o Paulo, Brazil) Introduction and Objectives: Toxoplasmic retinochoroiditis typically affects the posterior pole, and the lesions can be solitary, multiple or, classically, satellite to an old chorioretinal scar and usually accompanied by vitritis. Optical coherence tomography (OCT) can help in determining the location of the infiltrated inflammatory, damaged retinal layers and recognizing vitreoretinal complications. In this study we evaluated the vitreoretinal alterations in patients with Toxoplasmic retinochoroiditis. Methods: 53 eyes of 47 patients with active and inactive Toxoplasmic retinochoroiditis were studied. After the ophthalmologic exam, the patients were submitted to color fundus photography and OCT. In 10 patients with active uveitis, exams were performed before and after 3 and 6 weeks after the treatment. Results: The lesions were classified in inactive (18 eyes) and active in 35 eyes (24 focal and 11 satellites). The active lesion was characterized by increase of reflectivity of the internal layers of the retina with posterior shadowing and enhanced retina thicknesses in all cases. The posterior hyaloid was thickened and partially attached to the lesion in patients with active forms. During the follow-up, the OCT demonstrated decreased retinal thickness with increase of the reflectivity of the retinal pigment epithelium-choriocapillaris comp l ex (scar form ation) and posterior vitreous detachment. Vitreoretinal complications were exudative retinal detachment in 4 eyes, maculoschisis in 3, vitreomacular traction in 2, retinal folds in 3, epiretinal membrane in 6, macular hole and choroidal neovascularization in 1 eye. Conclusions: OCT was useful to demonstrate characteristic findings of the inflammatory process, scar development and retinal
complications of the Toxoplasmic retinochoroiditis. It revealed additional morphological findings as well as persistent macular alterations not clinically identified. Cross-sectional OCT images may increase the understanding of the pathophysiology of ocular toxoplasmosis. Financial fundings: (None.) Conflict of interest : (None.) Key wo rds: Ocular Tox o p l a s m o s i s , R e t i n o ch o roiditis, Optical coherence tomography
OP6-05 THE ROLE OF ULTRASOUND BIOMICROSCOPY IN ANTERIOR SEGMENT OCULAR INFLAMMATORY DISEASE Ursea Roxana (University of Arizona) Introduction and Objectives: Ocular inflammation involving the anterior segment can present diagnostic problems because it often involves structures that are not readily accessible by routine examination methods. Our goal was to assess the utility of ultrasound b i o m i c ro s c o py (UBM) in the evaluation and management of patients with ocular inflammation affecting the anterior segment. Methods: Retrospective, non-comparative review of the medical records of 39 patients with ocular inflammation involving the anterior segment examined with high-resolution ultrasonography. The findings were determined and the clinical relevance of UBM information was analyzed. Results: Abnormalities were found in 30 eyes of 22 patients with the following etiologic diagnoses: anterior uveitis (11), anterior scleritis (12), intermediate uveitis (7). Indications for UBM were: visualization of anterior chamber structures, visualization of ciliary body (CB), pre-operative assessment in eyes with hypotony or trauma, or poor visualization of the posterior segment, and for followup of documented abnormalities. We found 4 eyes with ciliary body detachment, 4 cyclodialysis clefts, 1 CB traction band, and 1 CB cyst. The UBM confirmed the clinical diagnosis and was useful only in the follow up of anterior scleritis patients. Unsuspected neoplastic CB masses were identified in 2 patients. In 16 cases UBM failed to reveal any new information. Conclusions: UBM has the ability to offer detailed images of the anterior segment using high-frequency ultrasound. In our series UBM was able to identify the cause of hypotony, discriminate between the various forms of anterior scleritis and follow and quantify ocular inflammatory changes over time. This noninvasive technique is useful for determining disease activity and for monitoring the clinical course. It also provides preoperative information critical to surgical planning. Financial fundings: N/A Conflict of interest : N/A Keywords: inflammation, ultrasound, imaging
OP6-06 CORRELATION BETWEEN IN VIVO CONFOCAL MICROSCOPY AND IMMUNOHISTOCHEMISTRY : THE CORNEAL ENDOTHELIUM IN AN ENDOTOXININDUCED UVEITIS MODEL TRINH LIEM (Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France. INSERM UMR S 872, Cord e l i e rs Biomedical Institute, P i e rre et Marie Curie
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Abstract Book University - Paris6, Paris Descartes University, Paris,F-75006 France. ) BRIGNOLE-BAUDOUIN FRANCOISE (Department of Toxicology, Faculty of Biological and Pharmacological Sciences, University of Paris 5 RenĂŠ Descartes, Paris, France. INSERM UMR S 872, Cordeliers Biomedical Institute, Pierre et Marie Curie Unive rsity - Paris6, Paris Descartes Unive rs i t y, P), LABBE A N TOINE (Dep a rtment of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France. INSERM UMR S 872, Cordeliers Biomedical Institute, P i e rre et Marie Curie University - Paris6, Paris Descartes University, Paris,F-75006 Fra n c e. ), BOURGES JEAN-LOUIS (Dep a rtment of Ophthalmology, Hotel Dieu Hospital, Paris, France. INSERM UMR S 872, Cordeliers Biomedical Institute, Pierre et Marie Curie University - Paris6, Paris Descartes University, Paris,F-75006 Fra n c e. ) , BAUDOUIN CHRISTOPHE (Dep a rtment of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, Fra n c e. INSERM UMR S 872, Cordeliers Biomedical Institute, Pierre et Marie Curie University - Paris6, Paris Descartes University, Paris,F-75006 France. ) Introduction and objectives: To analyze the involvement and modifications of the corneal endothelium in uveitis in order to understand the mechanisms of formation of keratic precipitates. The aim of this study was to correlate in vivo confocal microscopy images with ex vivo immunostaining of flat mounts of corneal endothelium from rat eyes with endotoxin-induced uveitis (EIU). Methods: EIU was induced in 12 Lewis rats by lipopolysaccharide (LPS) injection. Ophthalmologic examinations, including slit-lamp examination and in vivo confocal microscopy, were realized 6 and 24 hours after the LPS injection. Endothelium morphology and endothelial cells density in rats with EIU were compared to controls. Rats we re then killed 24 hours after LPS injection. Immunohistochemistry on corneal endothelium using antibodies to intercellular adhesion molecule (ICAM-1), phalloidin, CD68, MA967, alpha beta-TCR, ZO-1 and occludin was performed on flat-mount corneas and was analyzed using a 3D laser confocal microscope. Results: In vivo confocal microscopy showed numerous hyperreflective round dots on the corneal endothelium and in the anterior chamber probably corresponding to infl a m m at o ry cells. Endothelial cells density was similar between EIU rats and controls. On immunostaining, rats with EIU had an over-expression of ICAM-1. Compared to controls an expression of CD 68 (antimacrophage), MA 967 (anti-neutrophile) and alpha beta-TCR (anti-lymphocyte) was observed in EIU rats. ZO-1 and occludin had a lower expression and more heterogeneous repartition in EIU rats than in controls. Conclusions: The correlation between in vivo confo c a l micro s c o py and ex vivo immunohistoch e m i s t ry improved the understanding of in vivo confocal microscopy images. This original technique allows the precise evaluation of the corneal endothelium involvement in EIU. Using in vivo confocal microscopy in clinical practice could be helpful to evaluate keratic precipitates and corneal modifications in uveitis. Financial fundings: Study supported by unrestricted grants from INSERM UMR S 872, Cordeliers Biomedical Institute, Pierre et Marie Curie University â&#x20AC;&#x201C; Paris 6, Paris Descartes University, Paris,F-75006 France. Conflict of interest : There is no conflict of interest in this study Keywords: uveitis, corneal endothelium, confocal microscopy
OP6-07 QUANTITATIVE IMAGING OF FLUORESCENT LEUKOCYTES IN MICE Manivannan Ayyakkannu, Xu Heping, Liversidge Janet, Crane Isabel, Sharp Peter (University of Aberdeen) Introduction and Objectives: Leukocyte tracking is important to study the leukocyte-endothelial cell interactions which play an important role in the pathogenesis of various retinal inflammatory diseases. The traffic of these cells into retinal and choroidal tissue greatly determines the type of immune response. Infiltration of these cells can lead to tissue destruction resulting in visual loss. Optical methods such as scanning laser ophthalmoscopy allow the non invasive in vivo digital imaging of the leukocyte migration Methods: Leukocytes from mouse spleen were stained with different fluorophores, activated, and injected into the tail vein. Animals were anaesthetised and using a custom built scanning laser ophthalmoscope (SLO), the retina and ear were imaged using a very low power laser. High resolution digital retinal images were captured at 25 images/second for digital analysis of leukocyte dynamics. Images of circulating leukocytes in the retina were also recorded on DVD-R discs for up to 30 minutes and used to count the number of circulating cells under various conditions. Results: Various results of leukocyte dynamics comparing normal and diseased animals will be given. Real time video of cells rolling, sticking and migrating will be shown. Conclusions: The SLO provides valuable data of leuko cyte dynamics in murine retinal microcirculation both under physiological conditions and during the development of ocular disease. This method is non-invasive and is safe to use for up to one hour without any damage to the retina. Financial fundings: Welcome Trust, United Kingdom Conflict of interest : None Keywords: LEUKOCYTE IMAGING, SCANNING LASER OPHTHALMOSCOPY, CIRCULATION, FUNDUS IMAGING
OP7-01 FALSE-NEGATIVE ANTIBODY-BASED HLA-A29 TYPING IN PATIENTS WITH BIRDSHOT CHORIORETINOPATHY Cunningham Emmett Thomas (California Pacific Medical Center and Stanford University) Wender D Jon (California Pacific Medical Center), Fu D Arthur (California Pacific Medical Center), Jumper Michael J (California Pacific Medical Center), McDonald Richard H (Califo rnia Pa c i fic Medical Center), Johnson N Robert (California Pacific Medical Center) OBJECTIVES: To describe two patients with birdshot chorioretinopathy (BSC) associated with negative antibody-based testing for HLA-A29 expression and subsequent positive testing using a polymerase chain reaction (PCR)-based HLA subtyping technique. METHODS: Two patients with clinical characteristics typical of birdshot chorioretinopathy underwent testing for HLA-A29 antigen expression, first using antibody-based methods and subsequently using PCR-based HLA subtyping. RESULTS: In both patients, initial testing for the HLA-A29 antigen using antibody-based subtyping was negative, whereas subsequent testing using more sensitive and specific PCR-based methods was positive.
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Abstract Book CONCLUSIONS: Antibody-based HLA-A29 subtyping may be falsely negative in HLA-A29 positive patients with BSC. PCRbased subtyping should be considered in patients with characteristic BSC, particularly when antibody-based methods produce an unexpectedly negative result. Financial fundings: The San Francisco Retinal Foundation and The Pacific Vision Foundation Conflict of interest : None Keywords: UVEITIS, INFLAMMATION, DIAGNOSIS
OP7-02 VALIDATING TRIPLEX POLYMERASE REACTION FOR INFECTIOUS POSTERIOR UVEITIS Gupta Vishali (Post Graduate Institute of Medical Education and Research, Chandigarh), Gupta Amod (Post Graduate Institute of Medical Education and Research, Chandigarh), Arora Sunil (Post Gra d u ate Institute of Medical Education and Research, Chandigarh) Introduction and Objectives: To evaluate the efficacy of diagnostic triplex polymerase chain reaction assay for Tuberculosis, Fungi and Toxoplasmosis in infectious posterior uveitis. Methods: We established triplex PCR reaction using specific pri m e rs for M. Tuberculosis, Fungi and Toxoplasma gondi. The va l i d ation was done on 31 clinical samples (aqueous or vitreous humor). Of the 31 patients, 13 were Infection suspects (Group A) where any of the three i n fections was suspected. Six patients (Group B) we re uveitis controls who had non-infectious posterior uveitis wh e reas 12 patients (Group C) we re non-uveitis controls who underwent pars plana vitrectomy for other indications. All patients received specific therapy and results we re correlated with clinical outcome over a minimum follow-up of 6 months (median 9 months). Results: Seven of the thirteen patients in Group A, and none in Groups B and C were positive by triplex PCR reaction. Four of the samples were positive for M. Tuberculosis and three for Fungi. Conclusions: Triplex PCR reaction for M. Tuberculosis, Fungi and Toxoplasma gondi had high specificity and low sensitivity for detection of any of these pathogens. Financial fundings: Deparment of Science and Technology,New Delhi India Conflict of interest : None Keywords: Polymerase chain reaction, Tuberculosis, Infectious uveitis
OP7-03 EVALUATION OF THE NESTED-POLYMERASE CHAIN REACTION IN PERIPHERAL BLOOD DURING ACTIVE OCULAR TOXOPLASMOSIS Gomez-Marin Jorge E (Centro de Investigaciones Biomedicas, Universidad del Quindio), Lopez-Castillo A Cristian (Centro de Inve s t i gaciones Biomedicas, Universidad del Quindio), L o ra Fabiana (Centro de Investigaciones Biomedicas, Universidad del Quindio), de-la-To rre A l e j a n d ra (Centro de Investigaciones Biomedicas, Universidad del Quindio) P u rp o s e : to determine the diagnosis value of the nestedPolymerase Chain Reaction (n-PCR) through B1 gene amplified of Toxoplasma gondii in peripheral blood of patients with retinochoroiditis by toxoplasmosis. Design: test of a test. Gold standard: Clinical diagnosis based on
fundus examination performed by ophthalmologist and specific IgG anti-Toxoplasma positive in serum. Methods: patients with uveitis were distributed in three groups: I G ro u p : U veitis patients with an active ocular toxoplasmosis episode (10 patients). II Group: patients with inactive ocular toxoplasmosis (9 patients). III Group: uveitis patients without toxoplasmosis (5 patients). The n-PCR was performed using two pairs of primers targeting B1 gene of Toxoplasma gondii, made in two cycles. Results: we included 24 blood samples from the same number of patients attended in a referral center for uveitis in Armenia city. In the group patients with active ocular toxoplasmosis in 4 of 10 isolated (40%) amplified, 1 of 9 (11%) isolated of the inactive group amplified, and 2 of 5 isolated (40%) of the group of uveitis by others causes and with antibody IgG anti-Toxoplasma positives. Conclusions: the Polymerase Chain Reaction (n-PCR) in peripheral blood does not differentiate between active and inactive cases with ocular toxoplasmosis. It is possible amplify B1 gene in blood while patient has antibody IgG anti-Toxoplasma independently if they have or not ocular symptoms. Financial fundings: Universidad del Quindio Conflict of interest : NOne declared Keywords: Ocular toxoplasmosis, PCR, diagnosis
OP7-04 TUBERCULOSIS AND INTERFERON GAMMA RELEASE ASSAYS B ag l ivo Edoardo (Clinique d'Opthalmologi e, Hôpitaux Unive rs i t a i res de Genève), Janssens Je a n - Paul (Service de Pneumologie, Hôpitaux Universitaires de Genève) Introduction and objectives: Until now, the only way to identify underlying M tuberculosis infection was to use the tuberculin skin test (TST). TST measures cell-mediated immunity and is useful to detect latent TBC. In active TBC, this test is not a proof of activity. It becomes positive between 2 and 12 weeks after the infection and also signs a previous vaccination. Methods: Prospective study of subjects screened during contacttracing procedures between October 2004 and January 2006. Participants underwent simultaneous testing by TST (2U of RT23 Tuberculin, Statens Serum Institut, Copenhagen, DK) and TSPOT.TB (Oxford Immunotec, UK). 309 subjects (aged 40 ± 13 years, 52% M) were screened after exposure to 73 index cases of active pulmonary TB. Results: 166 subjects (54% M) had LTBI according to TST. 123 (40%) had LTBI according to T-SPOT-TB. Agreement between TST and T-SPOT-TB (kappa: 0.32) was low. Indication for treatment for LTBI according to results of either TST or T-SPOT.TB differed in 34% of patients. Referring to T-SPOT-TB, the total number of treatments would have decreased by 14% and avoided unnecessary treatment in 24% of subjects screened. Relying on TST alone would have led to 32 (10%) false negative results. Conclusions: T-SPOT-TB ap p e a rs to be more re l i able than TST fo r contact-tracing and detection of LTBI. At present, T-SPOT-TB cannot be recommended for monitoring efficacy of tre atment against active T B. T-SPOT-TB cannot diffe re n t i ate between active and lat e n t tuberculous infection, although there appears to be a loose re l ationship between activity of the disease and production of IFN-g. Th e perfo rmance of g-IFN assays in immu n o - s u p p ressed individuals must be more thoro u g h ly assessed: initial results are encouragi n g,
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Abstract Book although values are lower than in immuno-competent individuals. Financial fundings: none Conflict of interest : none Keywords: T-SPOT-TB, Tuberculosis, Mantoux
OP7-05 USEFULNESS OF HLA-B27 UND ACE-LEVEL IN ROUTINE UVEITIS SCREENING FOR DIAGNOSING ANKYLOSING SPONDYLITIS AND SARCOIDOSIS RESPECTIVELY - A BAYES ANALYSIS Becker Matthias D (Interdisciplinary Uveitis Center Heidelberg) Ja kob Eva (Interd i s c i p l i n a ry Uveitis Center Heidelberg), M a ckensen Friederi ke (Interd i s c i p l i n a ry Uveitis Center Heidelberg) The indication for various laboratory tests for routine screening in uveitis patients is controversially discussed. Since ankylosing spondylitis (AS) and sarcoidosis are common systemic diseases associated with uveitis, screening for HLA-B27 as well as ACE are part of a standard laboratory screening. This study calculates the usefulness of both tests for detecting both diseases by using Bayes' theorem. This formula allows a mathematical approach to assess the utility of a laboratory test calculating the probability of a disease when a test result is positive, based on the sensitivity and specificity of the test as well as the prevalence of the disease. The prevalence of the two diseases in a tertiary uveitis center was calculated using the uveitis database of the Interdisciplinary Uveitis Center Heidelberg, Germany (n = 1758). Sensitivities and specificities of the laboratory tests were taken from the literature. Post-test pro b ability for sarcoidosis for a uveitis patient was 19% if ACE level was elevat e d. If a patient with positive ACE level had intermediate uveitis the post test pro b ability was 30%. A positive HLA-B27 in a uveitis patient correlated in 28% with the final diagnosis of AS; if this patient had unilat e ral disease the pro b ability increased to 63%. Th e post-test pro b ability was 83% if the HLA-B27-positive patient had a re c u rrent, unilateral, a n t e rior uveitis and a male gender. These high probabilities mean that both tests are useful in the routine evaluation of patients with uveitis, but even more useful in certain subsets where post-test probabilities are increased. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Bayesian Analysis, diagnosis, systemic association
OP7-06 ALGORITHM OF THE DIAGNOSTIC PROCEDURE OF SARCOIDOSIS IN UVEITIS KODJIKIAN Laurent (Department of Ophthalmology, CroixRousse Hospital, Claude Bernard Lyon I University, Lyon, France), ABI-AYAD Neil (Dep a rtment of Ophthalmology, Croix-Rousse Hospital, Claude Bernard Lyon I University, Lyo n , France), GRANGE Jean-Daniel (Department of Ophthalmology, CroixRousse Hospital, Claude Bernard Lyon I University, Lyon, France), BROUSSOLLE Christiane (Dep a rtment of Internal Medicine, H么tel Dieu, 1 place de l'Hopital, Hospices Civils de Lyon, 69288 Lyon Cedex 02, France and University Claude Bernard Lyon 1), SEVE Pascal (Department of Internal Medicine, Hotel Dieu, 1 place de l'Hopital, Hospices Civils de Lyon, 69288 Lyon Cedex 02, France and University Claude Bernard Lyon 1) INTRODUCTION : Sarcoidosis is a chronic multisystem inflam-
matory disease. Diagnosis is often long and sometimes difficult to obtain in uveitis affected patients. We reviewed our diagnostic investigations and proposed our algorithm. MATERIALS AND METHODS : A retrospective review of 140 patients with uveitis followed in our institution between January 2003 and April 2007. An internist's consultation was systematic. We analyzed our diagnostic investigations. RESULTS : 26 Caucasians patients were identified. Angiotensin converting enzyme (ACE), chest x-ray and chest computerized tomography (CT) were systematically performed, with contributive results respectively in 67% (14/21), 24% (5/21), 52% (13/25); lymphocytic alveolitis evocative of sarcoidosis was present in 3/15 cases (20%); histological diagnosis was made in 54% (14/26): on 5/5 lymph node biopsies from mediastinoscopy, 2/2 skin lesions biopsies, 4/4 conjunctival lesion biopsy, and 1/14 biopsy of labial accessory salivary glands ; Among the 13 endobronchial biopsies performed during bronchofiberscopy, only 1 (8%) revealed the characteristic non caseating granuloma. Among 8 67Gallium citrate scintigraphy, only 38% (n=3) were contributive. Lastly, positron emission tomography with 18F-Fluorodeoxyglucose showed either mediastinal, cervical and/or lachrymal uptake in 10/10 patients. DISCUSSION : The evaluation of patients with uveitis caused by suspected sarcoidosis can be staged from non-invasive laboratory and radiologic tests to invasive ones, depending on the ease or difficulty of diagnosis. Our algorithm will be proposed. CONCLUSION : Pathology remains the gold standard of sarcoidosis diagnosis. Chest CT seems two times more accurate and sensitive than x-ray. As already described, ACE was often contributive. 18F-FDG-PET showed focal uptake suggestive of sarcoidosis in most of the patients and appears to be more accurate than 67Gallium scintigraphy. Financial fundings: none Conflict of interest : none Keywords: sarcoidosis , FDG-PET , chest computerized tomography
OP7-07 USEFULNESS OF AQUEOUS HUMOR A NA LYSIS FOR THE DIAGNOSIS OF POSTERIOR UVEITIS Rothova Aniki (University Medical Center Utrecht) de GrootMijnes D.F. Jolanda (University Medical Center Utrecht) PURPOSE: To assess the clinical usefulness of aqueous fluid analysis for the diagnosis and treatment of infectious posterior uveitis (PU). METHODS: Aqueous samples were examined by PCR and by p at h oge n - s p e c i fic analysis of intraocular antibody pro d u c t i o n (Goldmann-Witmer coefficient; GWC) for HSV, VZV, CMV and Toxoplasma gondii. Included were 152 patients with active PU (16 of whom were immunosuppressed). Controls consisted of 20 patients with Fuchs heterochromic uveitis and 20 non-uveitis cataract samples. RESULTS: Of 152 patients, 44 (29%) were positive in at least one diagnostic assay (37/136 (28%) immunocompetent and 7/16 (44%) immunocompromised patients). None of the controls were positive using PCR or GWC. A positive result was predominantly obtained in patients with focal chorioretinitis (37/87; 40%) and in extensive retinitis (7/9; 78%), whereas in multifocal chorioretinitis, neuroretinitis and retinal vasculitis only a few samples were positive (2/19, 1/29 and 0/10, respectively). Of 37 immunocompetent PU patients with a positive test result, 28 (76%) cases we re caused by
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 64
Abstract Book Toxoplasma gondii, while viral infections were most common in immunocompromised patients (5/7; 71%). In immunocompetent and toxoplasmosis PU patients GWC was the most informative assay (34/37; 92% and 28/30, 93%, respectively) in contrast to immunosuppressed patients (PCR positive in 5/7 and GWC positive in 4/7). Independent of the immune status of patients, positive PCR results were more frequently observed in viral infections than in toxoplasmosis (P<0.001). As a consequence of aqueous analysis, change of treatment was necessary in 36 patients (24%). None of the patients developed complications during and/or after aqueous sampling. CONCLUSIONS: Despite the posterior location of inflammation, aqueous analyses with PCR and GWC for HSV, VZV, CMV en Toxoplasma gondii revealed an infectious etiology in 29% of patients with PU. Financial fundings: Dr. F.P. Fischerstichting and Dutch Ophthalmological Research Foundation Conflict of interest : none Keywords: aqueous, posterior uveitis, intraocular infections
OP7-08 TOXOPLASMA GONDII IN THE PERIPHERAL BLOOD OF PATIENTS Rizzo Luiz V (Department of Immunology, Biomedical Sciences Institute, University of São Paulo (USP), São Paulo, Brazil; Fundação Zerbini, São Paulo, Brazil; Institute for Investigation in Immunology (iii), Brazilian Ministry of Science and Technology, São Paulo,) Silveira A Claudio (Department of Ophthalmology, Escola Paulista de Medicina – Federal University of São Paulo (UNIFESP), São Paulo, B ra z i l ) , Va l l o chi L Adriana (Lab Molecular Biology of Flavivirus, Oswaldo Cruz Institution (IOC), Oswaldo Cruz Fundation (Fiocruz), Rio de Janeiro, Brazil.), Silva R Ulisses (Dep a rtment of Immu n o l ogy, Biomedical Sciences Institute, University of São Paulo (USP), São Paulo, Brazil), Muccioli Cristina (Department of Ophthalmology, Escola Paulista de Medicina – Federal University of São Paulo (UNIFESP), São Paulo, Brazil), Belfort Jr Rubens (Department of Ophthalmology, Escola Paulista de Medicina – Federal University of São Paulo (UNIFESP), São Paulo, Brazil) INTRODUCTION AND OBJECTIVE: Toxoplasma gondii is an intracellular parasite that can cause substantial morbidity and mortality in man and animals. It has been isolated from infected hosts, usually animals and immunocompromised patients. We present evidences supporting the presence of T. gondii in peripheral blood of recently and chronically infected immunocompetent patients with or without toxoplasmic lesions. DESIGN/METHODS: A study of 18 patients from Erechim, Brazil, was performed to isolate tachyzoites from the blood. Patients were in good health and were HIV negative. Included were two patients with T. gondii-specific IgM and IgG antibodies and no ocular lesions (group 1); eight with T. gondii-specific IgG, but not IgM, antibodies and with recurrent retinochoroiditis (group 2); three with T. gondii-specific IgG, but not IgM, antibodies and inactive retinochoroidal scars (group 3); three with T. gondii-specific IgG, but not IgM, antibodies and no ocular lesions (group 4); and two without IgM or IgG anti-T. gondii antibodies or ocular lesions (group 5). Laboratory identification of T. gondii was done using immunofluorescence assay, direct observation by light microscopy and PCR. RESULTS: Tachyzoites were detected only in the peripheral blood
of 1 of 2 acute infected patients (group1) and 6 of 7 patients with recurrence of ocular lesions (group 2), and in no one chronic infected patients (groups 3 and 4) or no infected volunteer (group 5). CONCLUSION: Our results suggest the parasite circulates in the blood of immunocompetent individuals; including patients with remote infections and recurrent ocular toxoplasmosis. The relationship between recurrent ocular toxoplasmosis and parasitemia suggests that reactivation of ocular disease is not strictly a local event. Financial fundings: FAPESP (The State of São Paulo Research Foundation); CNPq (The National Council for Scientific and Technological Development) Conflict of interest : There is not conflict of interest. Keywords: Toxoplasma, tachyzoites, blood, ocular toxoplasmosis
OP7-09 ASSOCIATION BETWEEN TOXOPLASMA STRAIN VIRULENCE AND THE SEVERITY OF THE OCULAR DISEASE Silveira Claudio A M (Clinica Silveira), Rios S Lilia (Universidade de São Paulo - USP), Rizzo V Luis (Universidade de São Paulo USP), Muccioli Cristina (Universidade Federal de São Paulo UNIFESP), Belfort Jr Rubens (Universidade Federal de São Paulo - UNIFESP ), Grigg Michel (University of British Columbia) PURPOSE: To determine whether the strain of Toxoplasma gondii infecting patients from Southern Brazil correlates with the severity of ocular disease. METHODS: 263 sero samples were frozen at -20°C and were shipped to the University of British Columbia, Vancouver for analysis. The majority (249) of blood samples were obtained from infected patients from Silveira Clinic in Erechim, RS state, Brazil. In addition, 14 samples were collected from two small outbreaks. RESULTS: 249 sero samples were analyzed using a serological strain-typing test to identify the strain that caused infection. 127 samples were detected with the archetypal strains. 39 of these patients presented ocular lesions (31%). On the other hand, in 122 samples were detected atypical serotype strains. From these group, 68 patients presented ocular lesions (56%). 66 samples from patients with toxoplasmosis recently acquired (positive IgM) were clinically followed, The majority of these patients (49; 74%) were infected with archetypal strains, 88% of these did not develop any ocular lesions. In contrast, a significantly higher proportion of the remaining 17 patients that were infected by atypical strains had associated ocular lesions (5/17; 29%). Toxoplasma DNA isolated from the peripheral blood of 6 patients from the outbreaks that had atypical serotypes were subjected to multi-locus PCR-RFLP analysis with limited DNA sequencing at Washington University, Saint Louis., presenting the same results in relation to type I, II, III and atypical strains. Genotyping confirmed that these patients were infected with non-archetypal strains of Toxoplasma. CONCLUSION: An atypical serotype strain can be associated with severe ocular toxoplasmosis disease in patients in Brazil. These findings reveal that the genetic makeup of T. gondii is more complex than previously recognized and raise the possibility that unique or divergent genotypes may contribute to different clinical outcomes of toxoplasmosis in Brazil and possibly in other localities. Financial fundings: Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP)
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Abstract Book Conflict of interest : There is not any potential conflict/s of interest Keywords: Toxoplasma, atypical strain, virulence
OP7-10 TOXOCARA CANIS AND INTRAOCULAR INFECTION de Visser Lenneke (Department of Medical Microbiology and F.C. Donders Institute of Ophthalmology, University Medical Center Utrecht, The Netherlands) Rothova Aniki (F.C. Donders Institute of Ophthalmology, Unive rsity Medical Center Utre ch t , The Netherlands), de Boer H Jo ke (F.C. Donders Institute of Ophthalmology, Unive rsity Medical Center Utre ch t , The Netherlands), Kerkhoff T Frank (Department of Ophthalmology, Maxima Medical Center, Veldhoven, The Netherlands), van Loon M Anton (Department of Medical Microbiology, University Medical Center Utrecht, The Netherlands), de Groot-Mijnes D.F. Jolanda (Department of Medical Microbiology and F.C. Donders Institute of Ophthalmology, Unive rsity Medical Center Utre ch t , The Netherlands) Introduction and objectives: To investigate the role of Toxocara canis in posterior uveitis of undetermined origin. Methods: Paired ocular fluid (47 aqueous humor (AH) and 2 vitreous fluids) and serum samples of 37 adults and 12 children with undetermined posterior uveitis were retrospectively analysed for intraocular IgG antibody production against Toxocara canis by enzyme-linked immunosorbent assay and Goldmann-Witmer coefficient (GWC) determination. Previous diagnostic investigation by PCR and GWC for Herpes simplex virus, Varicella zoster virus and Toxoplasma gondii had not provided a cause of the posterior uveitis. Results: Three of 12 (25%) children showed intraocular IgG production against Toxocara canis. One child had vitritis, one presented with a low-grade uveitis and a peripheral retinal lesion and the third had uveitis posterior and a chorioretinal scar. All three children had AH IgG titers exceeding those of the corresponding serum. In fact, 2 children had very low Toxocara serum IgG titers (<1:16) and would have been considered seronegative upon routine serology screening. Intraocular antibody production aga i n s t Toxocara canis was absent in all 37 adults, including 5 seropositive patients. Conclusions: Our results indicate that ocular toxocariasis is mainly a pediatric disease. Serological screening is not informative for the diagnosis of intraocular Toxocara infection. Toxocara GWC analysis, however, can be of value when diagnosing patients with posterior focal lesions or vitritis of unknown etiology. Financial fundings: Supported by the Dr. F.P. Fischer Foundation and the Foundation for Dutch Ophthalmologic Research (SNOO). Conflict of interest : none Keywords: Toxocara canis, intraocular fluid, intraocular antibody production
OP7-11 INTRAOCULAR FLUID ANALYSIS FOR THE DIAGNOSIS OF INFECTIOUS UVEITIS IN IMMUNOCOMPETENT AND IMMUNOCOMPROMISED PATIENTS: PCR OR GWCâ&#x20AC;ŚOR BOTH? de Groot-Mijnes Jolanda DF (University Medical Center Utrecht; F.C. Donders Institute of Ophthalmology and Dept Medical Microbiology) van Loon M Anton (University Medical Center Utrecht; Dept Medical Microbiology) University Medical Center
Utrecht; F.C. Donders Institute of Ophthalmology Aniki Introduction and objectives: To evaluate the results of intraocular fluid analysis for the diagnosis of infectious uveitis in immunocompetent and immunocompromised patients. Methods: From October 2001 until December 2006, ocular fluids from 977 uveitis patients were examined for CMV, HSV, VZV, Rubella virus and/or Toxoplasma gondii using both polymerase chain reaction (PCR) and the Goldmann-Witmer coeffi c i e n t (GWC) analysis for intraocular antibody production. Results: Positive results were obtained in 256 (26%) cases. CMV was diagnosed in 23 (9%), HSV in 42 (17%), VZV in 57 (22%) and Toxoplasma in 105 (41%) patients. Rubella virus-positive outcomes were found in 29 (11%) cases, at least 72% of which had Fuchs heterochromic uveitis. If only PCR had been performed 39% of the herpesviral infections would have been missed; with only GWC analysis 22%. GWC analysis was of major value only in immunocompetent patients. In the immunocompromised group, PCR was positive in 94% of all positive cases. For ocular toxoplasmosis, 65% of diagnoses would have been missed by PCR alone and about 10% by GWC alone, irrespective of the immune status of the patient groups. In patients with clinical FHU, intraocular antibody production against rubellavirus was found in almost 100%. Moreover, Rubella virus RNA was found in the aqueous humor of 3 of 20 (15%) patients. Conclusions: Both GWC analysis and PCR should be used for optimal diagnostic inve s t i gations of immunocompetent and immunocompromised patients with infectious uveitis. Th e re appears to be a strong association between FHU and Rubella virus. Financial fundings: Dr. F.P. Fischer Foundation, The Netherlands Conflict of interest : There are no conflicts of interest. Keywords: intraocular fluid, polymerase chain reaction, intraocular antibody production.
OP7-12 PHASE 2/3 CLINICAL TRIALS OF A NOVEL CALCINEURIN INHIBITOR, LX 211, FOR THE TREATMENT OF NON-INFECTIOUS UVEITIS Nguyen Quan Dong (Wilmer Eye Institute, Johns Hopkins University School of Medicine) The LUMINATE (LX-211 Uveitis Multicenter Investigation of a New Approach to TrEatment) Uveitis Program Investigator Group Introduction: LX211 is a novel calcineurin inhibitor (CNi) possessing four-fold greater potency, an altered metabolic and pharmakokinetic profile, and potentially improved safety compared to the prototypical CNi, cyclosporine A. Three pivotal dose-ranging clinical trials have been designed to evaluate the safety and efficacy of LX211 as a steroid-sparing agent for the treatment, control, and maintenance of non-infectious posterior, intermediate, panuveitis, and anterior uveitis. Methods: Th ree global, prospective, double-masked, parallelgroup, dose-ranging, placebo-controlled, randomized multicenter studies comprise the LUMINATE Program, which is currently in progress in the United States, Europe, and Asia. In all studies, patients are randomized (2:2:2:1) to one of three doses of LX211 (0.2 mg/kg, 0.4 mg/kg or 0.6 mg/kg b.i.d taken orally) or placebo. S t u dy LX211-01-UV (LUMINATE Active) will eva l u ate 210 patients with active predominantly posterior manifestations. Study
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 66
Abstract Book LX211-03-UV (LUMINATE Anterior) will evaluate 100 patients with active predominantly anterior manifestations. Study LX21102-UV (LUMINATE Maintenance) will evaluate 220 patients whose disease is controlled and will be employed to spare the use of systemic corticosteroid and, if applicable, to replace the patientâ&#x20AC;&#x2122;s current poorly-tolerated corticosteroid-sparing agent. Results: The studies are ongoing. Primary endpoints in protocol LX211-01-UV are mean change from baseline in graded vitreous haze after 16 weeks and 24 weeks of therapy or at time of rescue. Protocol LX211-02-UV will assess proportion of subjects experiencing inflammatory exacerbation during 26 weeks of treatment. Protocol LX211-03-UV will assess mean change in graded anterior chamber cells after 16 weeks of therapy or at time of rescue. Secondary endpoints include corticosteroid utilization, rates of exacerbation, quality of life, macular edema, and visual acuity. Safety evaluation includes incidence and severity of adverse events. Interim results will be presented. Conclusions: The LUMINATE Uveitis Program consists of the first randomized placebo control trials for a corticosteroid-sparing immunosuppressive agent in different types of sight-threatening non-infectious uveitis. Financial fundings: The clinical trials are supported by LUX Biosciences, Inc. Conflict of interest : None of the investigators have any conflict of interests. Keywords: Calcineurin Inhibitor, LX 211, Clinical Trials
OP8-02 LONG-TERM OUTCOMES AND MANAGEMENT OF PATIENTS WITH SERPIGINOUS CHOROIDITIS Miserocchi Elisabetta (University Hospital San Raffaele, Milan, Italy) Modorati Giulio (University Hospital San Raffaele, Milan, Italy), Colucci Annalisa (University Hospital San Raffaele, Milan, Italy), Rama Paolo (University Hospital San Raffaele, Milan, Italy) Purpose: to describe the long-term outcomes and treatment man agement in 20 Italian patients with serpiginous choroiditis. Methods: a retrospective study of patients with funduscopic lesions consistent with diagnosis of serpiginous choroiditis, seen at the Ocular Immunology Service, University Hospital San Raffaele, Milan, was performed. The main outcome parameters evaluated were: demographic characteristics, duration of disease, duration of follow up, visual acuities, ocular complications, disease control, treatment management. Results: charts of twenty patients with serpiginous choroiditis (8 female, 12 male) with a median age of 60.5 years (range: 43-78) we re rev i ewe d. All patients presented with bilateral disease. Patients were followed for a median follow up time of 44.2 months (range 7-120). All patients were treated with systemic corticosteroids. Systemic immunosuppressants were given in addition to corticosteroids: 7 patients received only one immunosuppressant and 13 patients received multiple chemotherapeutic agents.The median long-term duration of treatment was 32 months (range: 26-45). Choroidal neovascularization occurred in 3 patients. At the end of our follow up 11 patients are in remission without treatment (long-term remission ranged from 17 to 86 months); 5 patients are controlled with systemic immunosuppressants and 4 patients continue to have recurrences of inflammation despite systemic aggressive treatment. Conclusions: systemic immunosuppressive treatment seems to reduce the rate of inflammatory recurrences and to favourably alter the long-term prognosis of patients with serpiginous choroiditis.
Nevertheless, there is a subset of patients who fail to achieve control of inflammation despite aggressive multiple immunosuppressive treatment. Financial fundings: no funding support Conflict of interest : no conflict of interest Key wo rd s : s e rp i ginous ch o ro i d i t i s , immunosuppressants, longterm outcome
OP8-03 CLINICAL ANALYSIS OF 171 PATIENTS WITH DUSN Garcia Carlos Alexandre (Federal University of Rio Grande do Norte, Brazil), Gomes Henrique B Alexandre (University Federal of Rio Grande do Norte), GARCIA FILHO ALEXANDRE CARLOS (FEDERAL UNIVERSITY OF RIO GRANDE DO NORTE BRAZIL), GARCIA CLAUDIA ME ANA (FEDERAL UNIVERSITY OF RIO GRANDE DO NORTE - BRAZIL), FREITAS GEOVANI ALISSON (FEDERAL UNIVERSITY OF RIO GRANDE DO NORTE - BRAZIL) Objective: Evaluate the determinant clinical signs to diagnose DUSN and treatment results. Methods: Clinical charts review of two series of patients diagnosed with DUSN between1992 and 1997 and between 2001 and 2006 were evaluated. Laser photocoagulation was performed when a live worm was found. Statistical analysis was also done. Results: The most frequent clinical signs were: subretinal tunnels (91.7%), retinal pigmentary epithelium atrophy (89.3%), white spots (80%), optic disc atrophy (76.98%), and live worm (40%). Visual acuity 20/200 or worse was found in 80%. Laser photocoagulation of the worm improved early stage visual acuity cases. Conclusion: DUSN is an important cause of blindness when the worm is not found in the early stage. Financial fundings: WE DID NOT HAVE ANY FUNDING FOR THIS RESEARCH Conflict of interest : WE DO NOT HAVE ANY FINANCIAL INTEREST IN THIS PAPER Keywords: DUSN, NEURORETINITIS, LIVE WORM, VITREITIS
OP8-04 HOW TO FIND A LIVE WORM IN DUSN Garcia Carlos Alexandre (Federal University of Rio Grande do Norte) Gomes Henrique B Alexandre (University Federal of Rio Grande do Norte), Garcia Filho Alexandre Carlos (Federal University of Sao Paulo), Garcia Claudia Me Ana (Federal University of Rio Grande do Norte), Segundo Souza Paulo (Federal university of Rio Grande do Norte) Objective: To show clinical signs that help in diagnosing and find a live and mobile worm in the sub-retinal space in DUSN. Methods: The best images and movies of the 121 patients with DUSN and the best image s and movies of retina, of 48 with live worm of 121 patients with DUSN were selected and it joined in a explained movie. Conclusion: Vitreits, p< 0.001 OR 10.59 IC (4.16 to 26.94) and recurrent white-yellowshided points (choroiditis, p< 0.001 OR 9.61 IC(2,59 to 35.70) are the mainly signs to find live worm in the early or late phase of the disease.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 67
Abstract Book Financial fundings: (None.) Conflict of interest : The authors do not have any financial interest Keywords: life worm, DUSN, choroiditis.
OP8-05 CONGENITAL TOXOPLASMOSIS IN PREGNA N T HEALTHY WOMEN WITH PROVEN OLD INFECTIONS AND LONG STANDING IGG CIRCULATING ANTIBODIES TO T GONDII Silveira Claudio A M (Clinica Silve i ra ) , Muccioli Cristina (Universidade Federal de São Paulo - UNIFESP), Vallochi L Adriana (Unive rsidade de São Paulo - USP), Rios S Lilia (Universidade de São Paulo - USP), Rizzo V Luis (Universidade de São Paulo - USP), Belfort Jr Rubens (Universidade Federal de São Paulo - UNIFESP) PURPOSE: To present cases of congenital toxoplasmosis in newborns whose mothers had positive serology for toxoplasmosis for years. DESIGN/METHODS: Case report. Four healthy women, HIV negative and with no known systemic disease and circulating IgG antibodies against Toxoplasma gondii for periods ranging from 3 to 20 years delivered children with Congenital Toxoplasmosis. SETTING/RESULTS: Case 1: A 38-year-old woman who had been treated for ocular toxoplasmosis 20 years earlier delivered a newborn who presented with a focal necrotizing retinochoroiditis characteristic of toxoplasmosis, as well as positive IgM serology for toxoplasmosis. The workup was negative for other entities. Case 2: A 31-year-old woman who had been treated for ocular toxoplasmosis 19 years earlier delivered a newborn who presented positive Ig M serology for toxoplasmosis at birth. Serology was repeated 4 times in the first year of life and always positive for the IgM and production of IgG. Up to now the child has not presented ocular lesions. Case 3: A 22 year-old woman, presented positive IgG serology for toxoplasmosis 3 years earlier she delivered a baby with macular bilateral retinochoroiditis and positive IgM serology. Case 4: A 25 year-old woman that in 2001 presented negative IgM and IgG against Toxoplasma during pregnancy and delivered a normal baby. Five years later she had a baby with macular bilateral retinochoroiditis. At that time the mother's serology was positive for IgM and IgG antibodies against Toxoplasmosis. CONCLUSION: These cases suggest that women with longstanding IgG antibodies to toxoplasmosis may be also at risk of transmitting the disease to the fetus causing congenital toxoplasmosis. Financial fundings: Clinica Silveira Conflict of interest : There is not any potential conflict/s of interest Keywords: Toxoplasma, pregnancy, IgG antibodies
OP8-06 WIDE VARIATION OF GENOTYPES IN OCULAR TOXOPLASMOSIS Uwe Pleyer (Department of Ophthalmology, Charité – University Medicine Berlin, Germany) Shobab Leila (Laboratory of Parasitic Diseases, N ational Institute of Health, Bethesda MD, USA), Liesenfeld Oliver (Institut für Mikrobiologie und Hygiene, Charité - Unive rsitätsmedizin Berl i n ) , G ri gg Michael (Lab o rat o ry of Parasitic Diseases, National Institute of Health, Bethesda MD,
USA) Introduction and objective s : Toxoplasmosis is a wo rl dwide occuring parasitic zoonosis and an important cause of posterior uveitis. The underlying organism T. gondii can be differentiated in 3 genotypes (I – III) that vary in virulence and epidemiological distribution. The severity of ocular toxoplasmosis is quite variabel and probably due to a combination of host and parasitic factors. The predominant strain associated with symptomatic infections in Europe are genotype II. In contrast Type I strains are considered to be mainly associated with ocular toxoplasma retinochoroiditis. Patients and methods: We serotyped strain-specific antibodies in 37 patients with confirmed ocular toxoplasmosis. Subsequently, in samples with atypical parasitic presentations the extracted DNA was amplified at the B1 and NTS2 loci to further differentiate the genotype of the parasite. Results: In 23 patients we identified Type II serotypes. Non-Type II serotypes were identified in 14 patients and out of these 7 possessed either a Type I or novel allele. Conclusions: This unusual bias toward Type I and /or atypical genotypes may have important implications for the epidemiology, transmission and treatment of ocular toxoplasmosis. Financial fundings: (None.) Conflict of interest : NONE Keywords: uveitis, toxoplamosis, genotype
OP8-07 FAMILIAL FORM OF BIRDSHOT RETINOCHOROIDOPATHY: REPORT OF FIVE FAMILIES TRINH LIEM, BODAGHI BAHRAM, FARDEAU CHRISTINE, CASSOUX NATHALIE, LEHOANG PHUC (Départment of Ophthalmology, Pitie-Salpetriere Hospital, Paris, France) Introduction and objectives: The birdshot retinochoroidopathy (BRC) is a chronic bilateral posterior uveitis strongly associated with HLA-A29 antigen. Despite an identified genetic predisposition, familial association has only been reported in the literature in a pair of HLA-A29 positive monozygot twins.This study reported familial cases of Birdshot retinochoroidopathy (BRC). Methods: Families which had at least two members with BRC were collected. We described and compared in each family between the two members: HLA typing, actual age, age at onset, ethnic group, clinical features, fluorescein and indocyanin green angiography, evolution of the disease, treatment used with efficiency and visual prognosis. Results: 5 families featuring two members in each (10 patients) suffering from BRC were included in this case serie, into a cohort of 225 patients followed up for BRC. HLA-A29 was positive in 100% patients tested. The mean age at onset was 46.5 years. The mean actual age was 56.1 years. All patients were Caucasian. 7 patients beneficiated from a corticosteroid treatment (70%), and 3 patients (30%) had no treatment because of moderate lesions. Only two patients from the same family were treated with cyclosporine (20% of all cases). Period of follow-up ranged from 1 year to 32 years (median of 7 years). Inside each family, the two members had a similarity prognosis and evolution in 60% of all cases. 6 patients had a severe form of the disease (60%). Conclusions: Familial form of BRC was reported in 5 families. The familial cases were very rare whereas there is a genetic risk factor HLA-A29 known.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 68
Abstract Book
Financial fundings: None Conflict of interest : No conflicting relationship exists. The authors have no financial interest in this study. There is no commercial connection between the authors and the topic. Keywords: Birdshot , family, HLA-A29
OP8-08 VOGT-KOYANAGI-HARADA DISEASE IN CHILDREN Abu El-Asrar Ahmed M. (King Saud University), Al-Kharashi S. Abdullah (King Saud University), Aldibhi Hassan (King Khaled Eye Specialist Hospital), Al-Fraykh Hamad (King Khaled Eye Specialist Hospital), Kangave Dustan (King Saud University) Purpose: To identify prognostic factors for outcome in children with Vogt-Koyanagi-Harada (VKH) disease. Methods: All children 16 years and younger with acute uveitis associated with VKH disease treated between 1999 and 2006 were reviewed. Results: Twenty-three children (46 eyes) were identified; 20 (87%) 2.4Âąfemales and 3 (13%) males with a mean age at presentation of 12.5 years. Mean follow-up period was 48.6 ? 30.8 months. Visual acuity (VA) of 20/40 or better was achieved in 38 (82.6%) eyes. Eleven eyes developed at least one complication, including cataract in 8 eyes, glaucoma in 8 eyes, subretinal neovascular membranes in 2 eyes and subretinal fibrosis in one eye. Disease recurred during follow-up in 18 eyes. Development of complications was negatively associated with final VA of 20/20 (p = 0.0317). Shorter interval between symptoms and treatment was a predictor of final VA of 20/20 (odds ratio = 10.4; 95% confidence interval = 1.61 ? 67.3). Recurrence of inflammation was significantly associated with development of complications (p=0.003), worse VA (p = 0.022) and presence of posterior synechiae of the iris at presentation (p = 0.0083), longer interval between symptoms and treatment (p = 0.013), initial treatment with intravenous corticosteroids (p = 0.0012) and rapid tapering of corticosteroids (p = 0.0063). Conclusions: Visual prognosis of VKH in children is generally favorable. Clinical findings at presentation, development of complications, interval between symptoms and treatment, recurrence of inflammation and method of tapering and use of intravenous corticosteroids were significant prognostic factors. Financial fundings: N/A Conflict of interest : N/A Keywords: Vog-Koyanagi-Harada disease, pediatric, uveitis
OP8-09 CLINICAL OUTCOMES OF INITIAL TREATMENT WITH PULSE INTRAVENOUS CORTICOSTEROIDS FOR VOGTKOYANAGI-HARADA DISEASE Okada Annabelle A (Kyorin University School of Medicine), Keino Hiroshi (Kyorin University School of Medicine), Watanabe Takayo (Kyorin University School of Medicine), Taki Wakako (Kyorin University School of Medicine) Objective: To assess clinical outcomes in patients with VogtKoyanagi-Harada (VKH) disease initially treated with pulse intravenous (IV) corticosteroids. Methods: Sixty-five patients with new-onset VKH disease presented over a 7-year period to the Kyorin Eye Center. All met the International Revised Diagnostic Criteria for VKH disease. Fifty-
two of the patients received initial treatment consisting of methylprednisolone 1000 mg/day IV for 3 days (pulse) followed by oral prednisolone 1 mg/kg/day tapered over 4 to 9 months. Sixteen patients received more than one pulse for an inadequate response to the first pulse. Thirteen patients were judged to have mild disease or systemic contraindications, and received less than pulse doses of corticosteroids either intravenously or orally. Results: Of the 52 patients (104 eyes) that underwent initial pulse treatment, a best-corrected visual acuity (VA) > 20/20 was achieved in 96 eyes (92%) at 3 months and 97 eyes (93%) at 1 year (n=104 eyes). Cataract was the most common reason for a VA < 20/20, and 4 additional eyes achieved a VA > 20/20 after cataract surgery subsequent to the 1-year follow-up. Only 1 eye had a VA < 20/200, and this was due to ch o roidal neova s c u l a ri z ation in the fove a . Recurrences occurred in 12 patients (23%), and mostly consisted of mild anterior chamber cells easily controlled with topical corticosteroids. Cyclosporine was used as a steroid-sparing agent in 5 patients (10%). Systemic complications due to treatment were observed in 14 patients (27%) and included transient hyperglycemia, worsening of diabetes mellitus, gastritis and liver dysfunction. Conclusions: Patients with new-onset VKH disease initially treated with pulse IV corticosteroids achieved excellent visual outcomes with few recurrences. Systemic complications related to treatment were observed in 27% of patients. Financial fundings: none Conflict of interest : none Keywords: VKH disease, corticosteroids, treatment
OP8-10 SPECTRUM OF VKH DISEASE IN NORTH INDIA. Gupta Amod (Post Gtraduate Institute of Medical Ediucation and research, Chandigarh), Gupta Vishali (Post Gtraduate Institute of Medical Ediucation and research, Chandigarh), Dogra Mangat (Post Gtraduate Institute of Medical Ediucation and research, Chandigarh), B a m b e ry Pra d e ep (Post Gtra d u ate Institute of Medical Ediucation and research, Chandigarh) Introduction and Objectives: To report the spectrum of VKH Disease in North Indian population. Methods: We reviewed the records of 63 patients of VKH seen in acute phase in our Uveitis clinic between 1990-2004. Based on the American Uveitis Society criteria, complete VKH syndrome developed only in 6% of patients. However, all the patients fulfilled the revised criteria proposed by Reed et al. The median follow-up was 2 years (range 1-14 years). Results: There were 40 women and 23 men with a median age at presentation of 35.6 years. Fluorecein angiography records were analysed for 104 eyes and initial hypofluorescent to late hyperfluorescent spots were seen in 80 eyes whereas the remaining 24 eyes showed early hyperfluorescent dots. ICG was done in 23 eyes and showed initial hypofluorescence in 10 and dilation of choroidal vessels with dye leakage. OCT in 10 eyes showed serous detachment and was a good tool for monitoring response to therapy. Women had onset at much younger age. All received systemic corticosteroids. Immunosuppressants were required only for four patients. Complications included Cataract in 67%, glaucoma in 19% and choroidal neovascular membrane in 8.1% of cases. Recurrences were seen in 74% of cases and a final visual acuity of 6/12 or better were achieved in 84% of eyes. During follow up only 5% of patients developed vitiligo.
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Abstract Book Conclusions: VKH syndrome in our population is mostly incomplete, with milder course and good response to corticosteroids. Financial fundings: None Conflict of interest : None Key wo rd s : VKH disease, Fundus fl u o rescein angiography, Corticosteroids
OP8-11 MACULAR EVALUATION IN VOGT-KOYANAGI-HARADA SYNDROME BY OPTICAL COHERENCE TOMOGRAPHY Andrade E Rafael, Muccioli Cristina, Farah E Michel, Belfort Jr Rubens (Instituto da Visão, IPEPO, Department of Ophthalmology, Federal University of São Paulo, Brazil) Introduction and Objectives: Vogt-Koyanagi-Harada (VKH) disease includes panuveitis associated with exudative retinal detachment, sunset glow appearance of the fundi, resulting in severe retinal pigment epithelial changes in convalescent stage. Permanent vision loss is the result of the complications that arise during the chronic-recurrent phase of the disease, including choroidal neovascular membranes and subretinal fibrosis. In this study we analyzed the macular abnormalities with optical coherence tomography (OCT) in patients with VKH syndrome. Methods: Thirty patients (90% female) had their macular anatomic status evaluated by OCT. Protocol was approved by ethical committee and all patients signed an informed consent prior entry into the study. Results: OCT findings comprised serous retinal detachment (24.2%), choroidal neovascularization (4,8%), subretinal fibrosis (1,6%), epiretinal membrane (3,2%) and cystoid macular edema (9,7%), as well as a new sign, not yet described in the literature, that appeared as a choroidal hyporeflectivity or edema of internal choroid (32,3%). Conclusions: The OCT was helpful to demonstrate the qualitative and quantitative anatomical alterations, having a good correlation with the visual acuity. It revealed additional morphological findings and persistent macular alterations despite of a favorable visual acuity outcome. Thus cross-sectional OCT images may increase understanding of the pathophysiology of VKH syndrome and a better disease monitoring might be achieved with such diagnostic tool.
Aim/Background: ICGA is highly sensitive to evaluate choroidal inflammation. We analyzed choroidal lesions using ICGA during the induction treatment phase of an initial inflammatory attack in 2 groups of VKH patients, one receiving prolonged high dose inflammation suppressive therapy (IST) (Lausanne=L) versus a mediumdosed corticosteroid treatment (MDCT) group (Tokyo=T). Methods: Medical records of VKH patients seen at the Japanese(T) and Swiss(L) centres who had pre-treatment and follow-up ICGAs till 4 months were reviewed. Standard care in both centers differed, prolonged high IST in L and medium dosed therapy in T given after a 3-day (1000 mgs of methylprednisolone) intravenous pulse therapy. ICGA findings [resolution of hypofluorescent dark dots(HDD)] and clinical outcomes were compared in both groups. Results: Nine patients (4 at L and 5 at T) were included. Mean oral daily corticosteroid dose during the 4-month period was respectively 0.75±0.2 mg/kg/day in the Swiss patients and 0.36±0.02 mg/kg/day in the Japanese patients (p<0.04) with 2/4 Swiss patients receiving also cyclosporin . All 9 patients had HDD granulomas of similar intensity in the choroid on pre-treatment ICGA. At 4 months, HDD had resolved in the Swiss group whereas in the Japanese group HDD persisted with almost identical intensity, although clinical improvement was similar in both groups. Conclusions: ICGA revealed persistent-extensive HDD after 4 months on medium dosed therapy (T) which completely disappeared with more aggressive IST (L), while similar clinical evolution in both groups was noted. Submaximally dosed IST seems to be insufficient to suppress the underlying lesional process in VKH and this probably explains evolution towards sunset glow fundus in seemingly controlled disease. More agressive ICGA-guided therapy for VKH disease seems recommended.
OP9-01
OP8-12
NEURO-OPHTHALMOLOGICAL MANIFESTATIONS OF HIV INFECTIONS IN INDIA IN THE ERA OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY Gharai Sujit (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India), Garg Satpal (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India), Ve n k atesh Pra d e ep (Dr. Rajendra Prasad Centre fo r Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India), Vohra Rajpal (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India), Sharma K S (Department of Medicine, All India Institute of Medical Sciences, New Delhi, India)
SUBOPTIMAL THERAPY CONTROLS CLINICALLY APPARENT DISEASE BUT NOT SUBCLINICAL PROGRESSION OF VOGT-KOYANAGI-HARADA DISEASE: AN ICG ANGIOGRAPHIC STUDY. Carl P. Herbort1,2,3 Tatsushi Kawaguchi3, Shintaro Horie3, Nadia Bouchenaki1, Kyoko Ohno-Mat s u i 3 , Manabu Mochizuki3 1) Inflammatory & Retinal & Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), La Sourc e, Lausanne, Switzerland 2) University of Lausanne, Lausanne, Switzerland 3) Department of Ophthalmology, Tokyo Medical & Dental University Graduate School, Tokyo, Japan
Introduction & Objective s : Eva l u ation of Neuro-ophthalmic manifestations in patients with HIV infection in the era of HAART at tertiary eye care centre in India. Methods: A detailed ophthalmological and systemic examination was performed on each patient between September 2004 and September 2006. Results: 135 consecutive HIV infected patients were examined. Of these 20% had category A HIV infection, 23.7% had category B HIV infection, 56.3% had category C HIV infection (AIDS indicator condition). The median age of patients w as 34 yr. 11.1% patients presented with neuro-ophthalmological manifestations.
Financial fundings: (None.) Conflict of interest : (None.) Key wo rd s : Vogt-Koya n agi - H a rada, Tomography, Macula
Optical
Cohere n c e
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Abstract Book 2/3rd patients had bilateral involvement. HIV related optic neuropathy (~5.9%) was the most common of neuro-ophthalmological manifestations. Other manifestations included neurogenic ptosis (3%), bilateral disc edema (2.2%), isolated left sided incongruous homonymous hemianopsia (~0.7%) due to CNS tubercular abscess and total ophthalmoplegia (~0.7%). The most common cause (~40%) of neuro-ophthalmological manifestations was cryptococcal meningo e n c ephalitis. Neuro - o p h t h a l m o l gical complicat i o n s had developed in 75% of cryptococcal meningitis patients. 3% patients presented to us with neuro-ophthalmic evaluation as presenting sign of HIV infection. Most of the optic neuropathy and all cases of bilateral disc edema were seen in patients with CD4 count <100 cells/?l. Conclusions: There seems to be an increased risk of developing neuro-ophthalmological complications, with the introduction of providing low cost or free HAART in India, due to increase in survival of patients with opportunistic infections with its residual complications, late presentation and delayed management in developing country. It also shows the importance of good coordination between internist and ophthalmologist for early diagnosis and prompt management. Financial fundings: nil Conflict of interest : none Keywords: Neuro-ophthalmic, HIV, HAART
OP9-02 TUBERCULOUS ORBITAL APEX SYNDROMES Hughes Edward H (St. Thomas' Hospital, London) Petrushkin Harry (St.Thomas' Hospital, London), Stanford R Miles (St.Thomas' Hospital, London), Graham M Elizabeth (St.Thomas' Hospital, London), Plant T Gordon (St.Thomas' Hospital, London) Introduction: Mycobacterium Tu b e rculosis infection (TB) is increasingly prevalent. Tuberculous orbital apex syndromes (TBOAS) are rare, but we report the clinical and radiological features of four patients who presented to the Medical Eye Unit at St. Thomasâ&#x20AC;&#x2122; Hospital with this condition in the last twelve months, and a further three cases from previous years. Methods: All disch a rge summaries from 1975-2006 were reviewed; the notes of positive cases were assessed in detail. Results: Seven patients (mean age 37.2 years) were diagnosed with TBOAS based on their clinical/radiological features and a positive Mantoux/Heaf test (100%) or lymph node biopsy (29%). All originated overseas, with minimum duration of UK residence of 3 years (mean 9.6, range 3 â&#x20AC;&#x201C;24yrs). Systemic symptoms were present in 43% and 86% had headache, but chest X-ray and cerebrospinal fluid examination were normal in all cases. Clinical signs included a unilateral optic neuropathy in 100% with presenting visual acuity of counting fingers or worse in 86%. All received anti-tuberculous chemotherapy and systemic steroids with a favourable outcome. Final visual acuity was 6/9 or better in 100%. Conclusions: TBOAS is rare but the incidence may be increasing. It often presents in the absence of systemic features of TB. Clinicians should be alert to this potential diagnosis, particularly in patients originating from TB-endemic areas. Financial fundings: (None.) Conflict of interest : (None.) Keywords: TUBERCULOSIS, OPTIC NEUROPATHY, ORBITAL APEX
OP9-03 HIV OPTIC NEUROPATHY - A SERIES OF 8 CASES Murthy Krishna R (Vittala International Institute Of Ophthalmology) Murthy B Kalpana (Vittala International Institute Of Ophthalmology), Rajagopalan Nirmala (Freedom Foundation), Satish B (Seva Clinic) Introduction: HIV retinopathy was thought to be the only lesion involving the retina, which was caused by the HIV virus itself. All the other retinal and optic nerve manifestations were thought to be caused by opportunistic infections or immunologic reactions. Aim: To present 8 patients of primary HIV optic neuropathy and to compare their vision, visual fields and retinal nerve fibre thickness. We also look at the possible mechanism of damage to the optic nerve. Material and methods: Eight patients who had primary HIV optic neuropathy were studied. All the patients underwent a complete ophthalmic evaluation, relevant serological tests and a lumbar puncture and cerebrospinal fluid examination when required to rule out syphilis, cryptococcal infection, varicella zoster and herpes simplex infection. A CT scan was ordered to rule out intracranial space occupying lesions. A diagnosis of exclusion of primary HIV optic neuropathy was made. All the patients were ordered visual field testing with the Humphrey visual field analyser and retinal nerve fibre layer thickness measurement with Heidelberg retinal tomogram. Six patients completed the visual fields test, 2 could not perform the test due to very poor vision. Two patients had the retinal nerve fibre layer thickness measured, in 2 the test was not possible due to poor vision and 4 patients were lost for follow-up. Results: Visual acuity was recorded in all 8. One patient was followed up with repeat fields at 3 monthly intervals and was found to have a gradual improvement of vision and visual fields. The retinal nerve fibre layer thickness in the 2 patients who underwent the test was within normal limits. Conclusion: Primary HIV optic neuropathy is a recognized cause of vision loss in HIV positive patients. It seems to respond well with treatment with HAART in the early phase of the disease. Financial fundings: none Conflict of interest : none Keywords: HIV, Optic Neuropathy, HAART
OP9-04 UNUSUAL INFLAMMATO RY MASS CASES OF THE ORBIT Briscoe Daniel M (Meir Medical Center, Kfar Saba, Israel) Gilad Litvin (Meir Medical Center, Kfar Saba, Israel), Ton Yokrat (Meir Medical Center, Kfar Saba, Israel), Kidron Dvorah (Meir Medical Center, Kfar Saba, Israel) Introduction and Objectives: The abundant availability of neuroimaging and oculoplastic surgery allow us to biopsy masses of the orbit routinely in recent years. We are therefore discovering unusual pathology more commonly than expected. The common use of an initial systemic steroid treatment trial is now more questionable. We reviewed the diagnosis and presentation of unusual inflammatoty lesions of the orbit biopsied over the past 8 years in our oculoplastic and orbital clinic. Materials and Methods: All patients were examined and worked up through the oculoplastic outpatient clinic. All cases had CT imaging of the orbits and underwent biopsy of the lesion. Pathology examination was performed on all specimens following
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 71
Abstract Book biopsy. Results: There were 5 cases of non caseating granulomas in the Orbit, 1 case of presumed Churg Strausse syndrome, 2 cases of lymphoid hyperplasia, 2 cases of infectious mononu cleosis dacryoadenitis, 1 case of lymphoma, and 1 case of angiolymphoid hyperplasia, and 1 case of Sclerosing type idiopathic orbital inflammatory disease and 2 cases of Eosinophillic Granuloma. Conclusions: We recommend biopsy of all orbital inflammatory masses before initiating treatment with steroids. Unusual pathology is more likely than expected and may have significant implications for the wellbeing of patients. Financial fundings: None Conflict of interest : none Keywords: Mass orbit inflammation
OP9-05 A CLINICOPATHALOGICAL STUDY OF ORBITAL LYMPHOMA CHARACTERISTICS IN 20 CASES Briscoe Daniel M (Meir Medical Center, Kfar Saba, Israel) Ton Yokrat (Meir Medical Center, Kfar Saba, Israel) Kidron Dvorah (Meir Medical Center, Kfar Saba, Israel) Introduction and objectives: A retrospective study of the medical data of 20 cases presenting with orbital lymphoma. Methods: All cases treated in Meir Medical Center between 1999 and 2007 diagnosed with orbital lymphoma were included. Clinical presentation, age, sex, tumor location, tumor type, imaging, pathology, and management were examined. Results: There were 9 men and 11 women, with age ranging between 49- 89 years old. Clinical presentation included: Drop in visual acuity (3), Proptosis (7), Eyelid lesions (6), Ptosis (1), Pain and squint (1), and Tearing, (2) Three of the lesions were located in the posterior orbit and 17 in the anterior orbit. 2 cases presented with optic nerve compression CT imaging was performed in all cases, and preliminary diagnosis was made based on the CT in 12 cases. In 4 cases the lymphoma was misdiagnosed on CT and interpreted as being meningioma, hemangioma, and probable benign mixed tumour of the lacrimal gland. All cases in this study were B cell type lymphomas and no T cell lymphomas were found. 9 cases had Malt type lymphoma, and 3 cases had a non Malt small cell lymphoma. 9 cases were primary orbital lymphoma and 11 cases were secondary, metastatic lymphoma. Haematoicytology studies where performed gave a reliable diagnosis of lymphoma within 5 hours. Follow up ranged between 2 months and 8 years. Conclusions: We found that orbital lymphomas generally appear in the anterior orbit and are almost exclusively of the B cell type. Although the number of primary and secondary cases are almost equal, metastatic lymphoma was more common in our series. CT examination was not very reliable in preoperative diagnosis (only 60%) with 20% having a mistaken primary diagnosis. Lymphoma should be considered in all space occupying lesions of the orbit and we recommend using haemocytological studies in all cases. Financial fundings: None Conflict of interest : None Keywords: Orbit, Lymphoma, Pathology
OP9-07 OCULAR INFLAMMATION SECONDARY TO SYPHILIS INFECTION: A 2 YEAR EXPERIENCE CHIQUET CHRISTOPHE (Dep a rtment of Ophthalmology, University Hospital, CHU de Grenoble, France), PAVESE PATRI CIA (Department of Infectious Disease, University Hospital, CHU de Grenoble, France), BOUILLET LAURENCE (Department of Internal Medicine, University Hospital, CHU de Gre n o ble, Fra n c e ) , PUECH CINDY (Dep a rtment of Ophthalmology, University Hospital, CHU de Grenoble, France), MAURIN MAX (Lab of Microbiology, University Hospital, CHU de Grenoble, France), ROMANET JEAN PAUL (Department of Ophthalmology, University Hospital, CHU de Grenoble, France) Introduction : to report ocular inflammation secondary to syphilis infection in a tertiary center. Methods : Within a prospective study (2 years, 2005-2007), we collected data on 7 male patients with ocular syphilis. The diagnosis was based on serology tests on blood sample and/or cerebrospinal fluid. All patients underwent a check up for ocular inflammation to rule out another etiological diagnosis and to detect another sexually transmitted infection. Results : Coinfection with human immunodeficiency virus was reported in 4 patients, with a CD4 T lymphocyte count greater than 300/mm3 in all cases. The ocular lesions were variable ; chorioretinitis (1 eye), retinal necrosis (2), panuveitis with macular edema (1), episcleritis (1), anterior optic neuropathy (1), and retrobulbar optic neuropathy (1). Infection of the cerebrospinal fluid was detected in 4/4 cases. The lumbar puncture was refused in 3 cases. In all cases, the inflammation was unilateral, and the anatomical and functional prognosis was excellent. Only one patient with the anterior optic neuropathy required systemic steroid therapy associated with antibiotics. Sequelae were a sectorial atrophy of the optic nerve (1 eye), and abnormalities of the retinal pigment epithelium (3 eyes). 6/7 patients were treated with ceftriaxone 2g/day during 3 weeks, with a good tolerance. One patient was treated with penicillin G. Conclusions : All patients with ocular syphilis exhibited a functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. In our area, the incidence of syphilis increases in immunocompetent and immunocompromised patients. As a great imitator, syphilis should be considered in all patients with uveitis or optic neuritis, especially in men with unprotected sexual behavior. Financial fundings: none Conflict of interest: none Keywords: syphilis, uveitis, sex transmitted disease
OP9-08 A NA LYSIS OF CROHNâ&#x20AC;&#x2122;S DISEASE-RELATED CARD15 POLYMORPHISMS IN SPANISH PATIENTS WITH UVEITIS Rodriguez-Perez Noellia (Inmunologia. Facultad de Medicina. Universidad Complutense de Madrid. Madrid. Spain), AguinagaBarrilero Ana (Inmunologia. Facultad de Medicina. Universidad Complutense de Madrid. Madrid. Spain) G o rro n o - E ch ebarria B. Marina (Servicio de Oftalmologi a . Hospital Universitario Principe de Asturias. Alcal de Henares), Perez-Blas Mercedes (Inmu n o l ogia. Facultad de Medicina. Universidad Complutense de Madrid. Madrid. Spain) Martin-Villa M. JosĂŠ (Inmu n o l ogia. Facultad de Medicina.
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Abstract Book Universidad Complutense de Madrid. Madrid. Spain) Introduction and objectives: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the digestive tract, and includes two entities: Crohn’s disease (CD) and ulcerative colitis (UC), and several mutations at the CARD15 gene have been involved in the susceptibility to suffer CD. Given the fact that some IBD patients may present uveitis and that altered intestinal permeability, a feature present in CD, has been reported in uveitis, we wished to analyse the fre q u e n cy of Crohn?s disease-linke d CARD15 mutations (P268S, R702W, G908R and 1007fs) in a group of Spanish patients with idiopathic uveitis. Methods: DNA samples we re obtained from 111 unrelated patients. P268S, R702W and G908R polymorphisms were detected using TaqMan Genotyping kits (Applied Biosystems), and the 1007fs mutation by direct DNA sequencing. Control group consisted of 105 healthy subjects. Results: None of the polymorphisms studied revealed a significant increase in the groups of patients, when compared to the control group. Thus, P268S is found in 50% of patients (gene frequency 0,284) vs 44% of control individuals (gene frequency 0,245); R702 in 7% of patients (0,036) vs 7% (0,033); G908R in 2% of patients (0.009) vs 4% (0,019) and, finally, 1007fs in 2% of uveitis patients (0,008) vs 5% (0,021). Moreover, DNA sequencing has allowed us to define two new intronic polymorphisms in phase, in the 5’ and 3’ boundaries of the exon 11 (GenBank accession number #DQ 869189) Conclusions: Crohn?s disease-linked CARD15 polymorphisms do not predispose to idiopathic uveitis in the Spanish population. Financial fundings: This work was supported by a grant from La Fundacion de Inve s t i gacion Medica Mutua Madrilena Automovilista. N R-P and A. A-B are grant recipients from the Universidad Complutense de Madrid. Conflict of interest : None Keywords: Uveitis, CARD15, Polymorphism
OP9-09 POSTERIOR UVEITIS IN SYSTEMIC SCLEROSIS OR LOCALISED SCLERODERMA BOUCHENAKI Nadia (Mémorial A. de Rothschild, Clinique Générale-Beaulieu, Geneva), BOUCHENAKI Nadia (Mémorial A. de Rothschild Clinique Générale-Beaulieu, Geneva ), FARDEAU Christine (Service d'Ophtalmologi e, Hôpital Pitié-Salpêtrière, Paris), CHIZZOLINI Carlo (Service d'Immu n o l ogie et d'Allergo l ogi e, Hôpitaux Unuive rs i t a i res de Genève, G e n eva ) , PIETTE Jean-Charles (Service de Médecine Interne, Hôpital PitiéSalpêtrière, Paris), LE HOANG Phuc (Service d'Ophtalmologie, Hôpital Pitié-Salpêtrière, Paris) Introduction: Within skin diseases characterized by dermal fibrosis localised scleroderma identify pathologies mainly restricted to the skin (linear scleroderma, morphea, en coup de sabre, etc.), while systemic sclerosis (SSc) includes conditions in which internal organs are involved in addition to the skin. SSc is considered an auto-immune disease characterized by fibrosis and fibroproliferative vasculopathy affecting small arteries and capillaries. Ocular manifestations, such as episcleritis, uveitis, xerophtalmia have been rarely described in association with scleroderma Patients and Methods: Six patients with posterior uveitis associated with SSc or localised scleroderma were studied retrospectively by analysing their clinical manifestations, fluorescein and indocyanine green angiographic patterns, visual field, as well their evo-
lution in response to treatment. Results: A non granulomatous posterior uveitis was present in all 6 patients (3 SSc, 3 localised scleroderma). Their mean age was 37.7 years (range 11-80 years), all were women. Four patients underwent fl u o rescein and indocyanine green angiography. Papillitis, retinal vasculitis, macular edema, pigmentary epithelium serous detachment, and peripheral exudation were present on fluorescein angiography in 3 cases. Indocyanine green angiogra phy showed a choroidal filling delay in the early phase and a diffuse posterior pole hyperfluorescence in the late phase (3 cases). Despite the use of systemic corticosteroids and immunosuppressant agents, 4 cases (3 localised scleroderma, 1 SSc) evolved progressively towards pigmentary epithelium atrophy with visual field concentric narrowing and electroretinogram abnormalities. Conclusions: Scleroderma can be rarely complicated by choroidal vasculopathy affecting the pigmentary epithelium and the retina with exudative phenomenon(pigmentary epithelium detachment, macular edema) that can result in progressive pigmentary epithelium atrophy with important functional damage. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Posterior uveitis, sclreoderma, choroidal vasculopathy, fluorescein angiography, indocyanine green angiography
OP9-10 CLINICAL MANIFESTATIONS AND LONG-TERM OUTCOMES AND PROGNOSTIC FACTORS OF DENGUERELATED OCULAR INFLAMMATORY DISEASE IN SINGAPORE TEOH Stephen C B (The Eye Institute @ Tan Tock Seng Hospital, Singapore), CHEE K L Caroline (National University Hospital), GOH Y Kong (The Eye Institute @ Tan Tock Seng Hospital, Singapore) Objectives: To characterise the presentations and long term outcomes in Dengue-related eye disease and visual prognostic factors in dengue chorioretinopathy. Methods: Consecutive non-interventional case series of 50 patients with dengue fever and impaired vision from dengue-related ocular i n fl a m m at o ry disease from the Tan Tock Seng Hospital and Communicable Disease Center, Singapore. Patient’s demographics, symptoms and signs were recorded with follow-up to 2 years. Visual acuity and fields were correlated with angiography and OCT findings in cases with posterior segment involvement. Results: Mean age was 31.7 years and predominantly men (68%). The most common visual complaints were blurring of vision (60%) and central scotoma (30%). Most patients recovered BCVA > 20/40. The most common signs noted in symptomatic patients were posterior segment involvement: macular edema (76.9%) with hemorrhage (69.2%) as well as foveal elevation (foveolitis) (33.8%). OCT showed 3 patterns of maculopathy: (1) diffuse thickening, (2) macular edema with subfoveal debris and (3) cystic foveolitis. Visual outcome was independent of amount of edema but scotomata persisted longest in pattern (3) and shortest in (1). Conclusions: Dengue-associated ocular inflammation is an emerging ophthalmic condition and often involves the posterior segment. Prognosis is variable. Patients usually regain good vision but may retain persistent scotomata even at 2 years despite clinical resolution of the disease. OCT patterns in dengue maculopathy are useful for characterisation, monitoring and prognostication of the visual defect.
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Abstract Book Financial fundings: NIL Conflict of interest : NIL Keywords: Dengue, Prognosis, Chorioretinopathy
OP10-02 C O N T ROLLED RELEASE OF STEROIDS FRO M INTRAOCULAR LENSES P. Furrer1, L. Bossy-Nobs1,2, S. Eperon2, O. Felt-Baeyens1, R. Gurny1 and Y. Guex-Crosier2 1 Department of Pharmaceutics and Biopharmaceutics, School of Pharmaceutical Sciences, Ecole de Pharmacie Gen?ve-Lausanne, University of Geneva, CH-1211 Geneva 4, Switzerland 2 Hôpital Ophtalmique Jules Gonin, University, 1000 Lausanne 7, Switzerland Introduction and objectives: Ocular inflammations are frequently observed after cataract surgery and they require for their treatment high doses of steroids via oral or injection route. Moderate efficacy and secondary effects are often associated with such treatment. Thus, it is of great importance to develop a system that releases the drug within the eye at low level. The present study aims to develop a biodegradable drug delivery system (DDS) able to release steroids over several months. Methods: DDS were manufactured using poly(D,L-lactide-co-glycolide) as matrix. The amount of steroids loaded in DDS was evaluated as well as the release profile of the drug. Cataract surgery was performed on the right eye of pigmented rabbits followed by DDS insertion. Inflammation parameters were: i) the clinical score (sum of hyperemia, chemosis, edema and secretion, each scored from 0 to 3), ii) the number of inflammatory cells and iii) the protein concentration in aqueous humor (AH). Results: The DDS weighed 2.94 ? 0.08 mg and measured 2.1 ? 0.2 mm. The g of drug per mg ofÌloading capacity was approximately of 338 ? 7 polymer. The in vivo investigations showed a good ocular biocompatibility. Comparisons were made between rabbits wearing i) no DDS, ii) unloaded DDS and iii) loaded DDS. Loaded DDS could significantly reduce ocular inflammation induced by surgery, especially protein concentration within AH. Conclusions: The results suggest that our type of DDS loaded with TA would be a promising system for the delivery of steroids to reduce ocular inflammation. Financial fundings: This work was supported by a grant from Swiss National Science Fo u n d ation (#3200B0-105337/1) and the Novartis Consumer Health Foundation Conflict of interest :None Key wo rd s : i n t raocular lens, c o n t rolled drug delive ry system, steroids
Introduction and objectives: Cataract surgery induces a postoperative inflammation. We developed a new concept of all-in one drug delivery system associated to an intraocular lens (DDS-IOL). Methods: The DDS were prepared using poly (D,L-lactide-co-glycolide) (PLGA) with different Mw. The DDS loaded with triamcinolone acetonide (TA). DDS-IOL was tested in a model of cataract surgery by phacoemulsification. The DDS-IOL was implanted in a model of pigmented rabbits. Anterior chamber puncture was performed at one, two and three weeks. Postoperative inflammation was followed by aqueous humor cell count and protein concentration in the aqueous humor. Results: In vitro release studies indicated that the higher the Mw of the DDS, the slower was the release of TA. The DDS of 3 mg contains around 1 mg of TA. Unloaded DDS did not induce more inflammation than IOL without DDS, indicating a good ocular biocompatibility. Rabbits were implanted with IOL wearing i) no DDS (n=4), ii) unloaded DDS (n=4), iii) one loaded DDS (n=7), iv) two loaded DDSs (n=6). One loaded DDS (Mw=48’000 Da) could significantly reduce ocular inflammation induced by surgery. Inhibition of protein migration reached 58%, 76% and 61% at 7, 14 and 21 days after surgery, respectively. Two loaded DDS could inhibit inflammation by 94% at 7 days, 97% at 14 days and 90% at 21 days after surgery. Conclusions: Post-operative inflammation was reduced significantly by DDS-IOL, loaded with triamcinolone acetate. This DDSIOL could be later used as a carrier of various anti-inflammatory or anti-angiogenic molecules when cataract surgery is simultaneously performed. Financial fundings: Swiss National Fund FNRS 3200BO-105337/1 Conflict of interest : none Key wo rds: Drug delivery system, biopolymer, triamcinolone acetate, cataract surgery
OP10-04 INTERFERON ALPHA TREATMENT CONTRIBUTION IN BIRDSHOT RETINOCHOROIDOPATHY MANAGEMENT. Fardeau Christine (Dep a rtment of Ophthalmology PitiéSalpétrière Hospital, U n iversity Pa ris VI, Paris) Vandamme Sebastien (Department of Ophthalmology Pitié-Salpétrière Hospital, Unive rsity Paris VI, Paris), Cassoux Nathalie (Dep a rtment of Ophthalmology Pitié-Salpétrière Hospital, University Paris VI, Paris), Bodaghi Bahram (Department of Ophthalmology Pitié-Salpétrière Hospital, University Paris VI, Paris), Le Thi Huong D (Department of Medicine Pitié-Salpétrière Hospital, University Paris VI, Paris), LeHoang Phuc (Department of Ophthalmology Pitié-Salpétrière Hospital, University Paris VI, Paris)
OP10-03 A NEW DRUG DELIVERY SYSTEM ASSOCIATED WITH AN INTRAOCULAR LENS (DDS-IOL) IN A MODEL OF CATARACT SURGERY IN RABBITS. G u ex - C rosier Yan (Jules Gonin Eye Hospital, U n ive rsity of L a u s a n n e, Switzerland) Guex - C rosier Yan (Jules Gonin Eye Hospital, University of Lausanne, Switzerland), Eperon Simone (Jules Gonin Eye Hospital, University of Lausanne, Switzerland), Bossy-Nobs Leila (School of Pharmaceutical Sciences, University of Geneva, Switzerland), Petropoulos Ioannis (Jules Gonin Eye Hospital, University of Lausanne, Switzerland), Gurny Robert ( S chool of Pharmaceutical Sciences, University of Geneva, Switzerland)
The Birdshot retinochoroidopathy (BRC) induces a high rate of macular edema the first line treatment consists in steroid therapy. In case oh high daily dose of steroid dependence, immunosuppressive agents with possibly severe side effects are added. We evaluate the outcomes of 2a as an immunomodulator and·patients treated with interferon steroid-sparing agent in a retrospective noncomparative interventional case series. Patients and Method : Twenty successive patients with BRC treated first with systemic steroid therapy and showing both (1) a relapse of macular edema with a daily prednisone dose superior to 0.3mg/kg and (2) no exclusion criterias to interferon alpha treatment were included.
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Abstract Book Main outcome measures : central macular thickness measured by optical coherence tomography, steroid-sparing effect, best corrected visual acuity, inflammatory signs visible in retinal angiography, and adverse reactions were measured at 6 months and at the end of individual follow up. Results : At 6 months the macular thickness was significantly decreased (p=0.2) and a normal macular profile was obtained in 18/35 eyes (51%) at six months. The daily prednisone dose was significantly decreased from 34 to 15 mg/d. Visual acuity was improved in 54 eyes. The side effects lead to discontinue the interferon treatment in 3 patients. 2a could be usefull in the treatment of BRC·Conclusion : interferon with both ME and high daily dose steroid dependence. This immunomodulator drug could be suggested in combined steroid therapy before the conventional immunosuppressive agent. Financial fundings: none Conflict of interest : none Keywords: Birdshot retinochoroidopathy, interferon alpha, macular edema
OP10-05 INFLIXIMAB TREATMENT FOR REFRACTORY CHILDHOOD UVEITIS Ayranci Ozen (Istanbul University Istanbul Faculty of Medicine, Ophthalmology Dep a rt m e n t ) , Tugal-Tutkun Ilknur (Istanbu l University Istanbul Faculty of Medicine, Ophthalmology Department), Kasapcopur Ozgur (Istanbul University Cerrahpasa Faculty of Medicine, Department of Pediatry) Introduction and objectives: To report our experience with infliximab for the treatment of refractory childhood uveitis. Methods: A retrospective review of 16 patients who were treated with intravenous infusions of infliximab (5 mg/ kg/ dose) for uveitis resistant to conventional immunosuppressive therapy. Six patients had juvenile idiopathic arthritis (JIA) associated uveitis, 6 patients had pars planitis (PP), 3 patients had idiopathic uveitis, and 1 patient had Behçet's disease. Induction doses were given at week 0, 2, and 6; and infusions were repeated every 8 weeks as maintenance therapy. All patients received an antimetabolite agent during infliximab therapy. Results: Eleven patients were male, 5 patients were female. Mean age was 6.9 (3–14) years. Median duration of infliximab treatment was 12 months (range, 3-51 months) All patients were initially responsive to infliximab therapy. Corticosteroids were discontinued in 15 patients. Resistance developed after 10-36 months in 4 patients (2 JIA, 1 PP, 1 Behçet's), and infusions had to be given at shorter intervals and cyclosporin was added in 3. Infliximab was discontinued in 1 JIA patient because of treatment fa i l u re. Infliximab infusions were stopped in 4 patients after 6-13 months (2 JIA, 2 PP) because remission could be maintained with only antimetabolites. Complications of treatment included herpes zoster in 2 patients, herpes labialis in 1 patient, sinusitis in 1 patient, and development of anticardiolipin IgM antibodies in 1 patient. Conclusions: Favorable short-term results are obtained with infliximab therapy in children with uveitis refractory to conventional agents. Long-term results are va ri abl e. Despite concomittant antimetabolite treatment resistance to infliximab may develop with long-term treatment. Financial fundings: (None.) Conflict of interest : (None.) Keywords: infliximab, childhood, uveitis
OP10-06 BRUSH CYTOLOGY SCORE SYSTEM (BCSS) GRADES INFLAMMATION IN DRY EYE PATIENTS VERSURA Piera (Dept Ophthalmology, Alma Mater Studiorum Unive rsity of Bolog n a ) , PROFAZIO Vi n c e n zo (Dept Ophthalmology, Alma Mater Studiorum University of Bologna), COSLOVI Chiara (Dept Ophthalmology, Alma Mater Studiorum University of Bologna), CAMPOS C Emilio (Dept Ophthalmology, Alma Mater Studiorum University of Bologna) Purpose: Despite increasing scientific evidence on the role of subclinical inflammation in dry eye, an evaluation system of conjunctival brush cytology has not been validated yet. We propose Brush Cytology Scoring System (BCSS) as a reliable method to score ocular surface inflammation in dry eye. Methods: 10 normal subjects and 15 patients with dry eye of various severity were included. Clinical signs were assessed using a score of 0 (none) to 3 (severe) for each eye and the subjective symptoms with the OSDI questionnaire. Exudated serum albumin and IL-6 in tears were evaluated. Conjunctival cytology samples were obtained from lower and upper lids, processed and independently examined at LM. The number of neutrophils, eosinophils, basophils, lymphocytes and monocytes were counted in 30 consecutive 400x microscopic fields and staged on a scale of 0-4, sum BCSS ranged 0-20. Statistical evaluation was performed by applying the unpaired Student’s t-test and the Pearson correlation test (significance p<0.05). BCSS was also analysed for sensitivity, specificity, ROC curves, likelihood ratio LR+, positive (PPV) and negative (NPV) predictive values. Results: BCSS was positively correlated to clinical sign score, OSDI score, exudated serum albumin and IL-6 in either control (Pearson’s correlation test respectively p<0.05, p<0.001, p<0.001 and p<0.01) and in dry eye patients (p< 0.001, p<0.01 and p<0.003). BCSS > 6 was selected as cut off value for moderate dry eye (LR+ 12,7; PPV 24,5), BCSS >11 was selected as cut off value for severe dry eye (LR+ 21,3; PPV 32,6). Conclusions: BCSS can be applied in any trained laboratory; our findings suggest it is correlated with clinical signs and symptoms, showing good diagnostic performance to grade inflammation in dry eye patients. Financial fundings: This work was supported in part through a grant from the Fondazione Cassa di Risparmio in Bologna to Prof. Emilio Campos Conflict of interest : (None.) Keywords: CONJUNCTIVA, CYTOLOGY, SCORE
OP10-08 TREATMENT AND PREVENTION OF ELEVATED INTRAOCULAR PRESSURE DUE TO INTRAVITREAL STEROIDS BY ANECORTAVE ACETATE (3, 12, 24 MG) Callanan David (Texas Retina Associates / Univ. of Texas Southwestern Med. Ctr.), Dickerson Jaime (Alcon Laboratories, Inc.), Landry Theresa (Alcon Laboratories, Inc.) Introduction: Elevated intraocular pressure (IOP) and glaucoma are serious complications of uveitis that increase in frequency and severity with the use of steroids. This study examines the efficacy of Anecortave Acetate (AA) in lowering IOP induced by intraocular steroids. Methods: Eight patients with steroid-induced glaucoma were treated in study #1. Five had received intravitreal triamcinolone (4 mgs in 4 patients; 16 mgs. in 1 patient) and 3 had received a Retisert
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Abstract Book (fluocinolone) implant. All developed significant IOP elevation after steroid and before anecortave was administered. They were given an anterior juxtascleral depot (AJD) of AA at one of three doses (24, 12, or 3 mg) and followed for an average of 18.6 months ( range 17-21 months). In study #2, 9 patients with a Retisert implant are being given a prophylactic AJD injection of AA every four months following initial placement of the Retisert implant. This is being done to determine whether the prophylactic use of AA before the patient develops elevated IOP will decrease the high occurrence of elevated IOP associated with the Retisert implant. Results: The eight patients in study 1 had a mean IOP at AA injection of 30.0 ± 5.1 mmHg. The mean maximum decrease post AJD of AA was 8.9 ± 3.8 mmHg. The average time to the maximum effect was 24.6 ± 21 days. All of the patients with a Retisert implant in study #2 receiving prophylactic anecortave acetate have an IOP that is in the normal range with an average follow-up of 6 months (range 4-11 months). Only two of the 9 Retisert patients are on IOP lowering drops. Conclusion: AA effectively lowers IOP in steroid-induced glaucoma. Its efficacy in preventing IOP elevation in uveitic patients with a Retisert implant is under study. Financial fundings: Alcon Laboratories, Inc. Conflict of interest : Alcon Advisory Board Keywords: glaucoma, treatment, anecortave
OP11-01 INFECTIVE ENDOPHTHALMITIS CAUSED BY MULTIDRUG RESISTANT BACTERIA IN SOUTHERN INDIA. Pathengay avinash (Visakhapatnam L V Prasad Eye Institute), Morekar Mayur (L V Prasad eye instiute), Das Ta rap ra s a d (Bhubneswar L V Prasad Eye Institue), Sharma Savitri (Bhubneswar L V Prasad Eye Institue) INTRODUCTION: To determine the prevalence, causative bacteria and visual outcome of culture-proven endophthalmitis caused by multidrug resistant (MDR) bacteria at a tertiary eye care centre in south India. METHODS: A retrospective chart review of culture proven consecutive patients of clinically suspected bacterial endophthalmitis between January 2000 and December 2004 was done. Microbiological work-up of vitreous included microscopy, culture and antimicrobial susceptibility (Kirby-Bauer disc diffusion assay). MDR was defined as resistance to two or more different groups of antibiotics. The best corrected visual acuity of < 20/200 at final follow-up was defined as a poor visual outcome. RESULTS: Vitreous from 32 (7%) of 498 patients yielded MDR bacteria in culture. Twenty three (72%) of these patients had a poor visual outcome. MDR was more common in gram-negative bacteria (28; 87%) compared to gram-positive (4; 13%). Pseudomonas spp. (20 isolates) was the commonest gram-negative bacteria. Ten (36 %) of the 28 gram-negative isolates were resistant to ceftazidime, 14 (50%) to amikacin and 4 (14%) of these 28 isolates were resistant to both amikacin and ceftazidime. CONCLUSION: Multidrug resistance was not frequent in bacteria causing endophthalmitis. Pseudomonas spp. was the commonest multidrug resistant organism in this study. The visual outcome in a majority of the cases was poor. Financial fundings: nil Conflict of interest : nil Keywords: Endophthalmitis,Multidrug resistance,Southern India
OP11-02 PEDIATRIC UVEITIS IN A TERTIARY REFERRAL CENTER Gupta Amod (Post Graduate Institute of Medical Education and Research , C h a n d i garh- India), Gupta Vishali (Post Gra d u at e Institute of Medical Education and Research, Chandigarh- India), Singh Ramandeep (Post Graduate Institute of Medical Education and Research , C h a n d i garh- India), S a ch d ev Nishant (Post G ra d u ate Institute of Medical Education and Research, Chandigarh- India) Introduction and objectives: To report the pattern of uveitis, complications and visual outcomes of pediatric patients in a large tertiary eye center. Methods: In a retrospective study, the records of all pediatric uveitis cases from January 1996 to June 2005 were reviewed for demographics, anatomic data, diagnoses, systemic associations, and visual outcomes. Results: 100 (53.19%) were males and 88 (46.81%) females. The anterior uveitis was the commonest (38.82%). Mean follow-up was 45.2 months. A specific diagnosis could be established in 117 patients (62.23%). The infective etiology was seen in 48 (25.53% of all uveitis cases), of which tuberculosis (27 patients, 14.36% of all uveitis cases) was the commonest. Specific non- infective etiology was seen in 78 (41.48% of all uveitis cases) patients, of which JIA (26 patients, 13.82% of all uveitis cases) was the commonest. Complicated cataract was the most frequent complication (16.15% of the total eyes). Conclusions: Tuberculosis and toxoplasmosis among the infectious and JIA associated uveitis among non-infectious etiology were the commonest form of uveitis among children. Financial fundings: None Conflict of interest : None Keywords: Peadiatric, uveitis, epidemiology
OP11-03 RECURRENCES IN OCULAR TOXOPLASMOSIS: FREQUENCY AND CLINICAL RELATED FACTORS de-la-Torre Alejandra (Centro de Investigaciones Biomedicas, U n iversidad del Quindio) Gomez-Marin E Jorge (Centro de Investigaciones Biomedicas Unive rsidad del Quindio), RiosC a d avid C Angela (Centro de Investigaciones Biomedicas, Universidad del Quindio), Cardozo-Garcia M Carlos (Centro de Investigaciones Biomedicas, Universidad del Quindio) Aim: To determine the frequency and clinical related factors for recurrences in toxoplasmic retinochoroiditis. Setting: Referral clinical consultation for uveitis at the Quindio university medical center (Colombia) between september 2005 to november 2006 Study design and inclusion criteria: Case series analysis based on clinical charts. Patients with retinochoroidal lesions at eye?s fundoscopy, IgG anti-Toxoplasma serological assay positive and at least two years of following were included in the study. Data were analyzed for demographic and clinical c haracteristics: age, sex socioeconomical levels, number of scars, sinechiae, papilar exacavation size, specific IgG and IgM anti Toxoplasma results; PCR assay result, medicaments, congenital or acquired origin and retinal localization area. Results: In 60 cases that were analyzed, 27 fulfilled the inclusion criteria. A total of 44 recurrences were found during a 3,063
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Abstract Book months of following, thus indicating that occurs 1.6 of recurrent episode each 10 years. We standardized the number of recurrences by the months of following and we found that subconjunctival injection of steroids, azythromycin treatment and use of systemic steroids were related with a greater number of recurrences. Conclusions: The number of recurrences in our population is similar to that previously described in other studies. Subconjunctival or systemic steroids and azythromycin were related significantly with recurrences. Financial fundings: Universidad del Quindio Conflict of interest : None declared Keywords: Ocular toxoplasmosis, recurrences,
OP11-04 EPIDEMIOLOGY AND CLINICAL COURSE OF BEHÇET’S DISEASE IN THE REGGIO EMILIA AREA, NORTHERN ITALY. Cimino Luca (Arcispedale S.M. Nuova, Reggio Emilia, Italy), Salvarani Carlo (Arcispedale S.M. Nuova, Reggio Emilia, Italy), Boiardi Luigi (Arcispedale S.M. Nuova, Reggio Emilia, Italy), Cappuccini Luca (Arcispedale S.M. Nuova, Reggio Emilia, Italy) Introduction and Objectives:: To investigate epidemiology and clinical course of Behçet’s disease (BD) over a 17-year period in a defined area of Northern Italy. Methods: All patients resident in the Reggio Emilia area who fulfilled the International Study Group criteria for BD were enrolled over a 17-year period. The follow- up lasted from the time of diagnosis until either their death or April 1, 2005. Results: Eighteen patients had complete BD. Mean age at diagnosis was 33+7 years. The average annual age- and sex-adjusted incidence rate of complete BD was 0.24/100,000. The age- and sexadjusted prevalence of BD was 3.8/100,000. No patients died during the follow-up period. Although all patients developed oral ulceration during the disease course, 22.2% had no oral lesion at disease onset. Cutaneous lesions, eye disease, genital ulcers and arthritis occurred in 33.3%, 27.8%, 16,7% and 16.7% of patients at disease onset, while they were observed in 100%, 55.6%, 77.8% and 50% of patients during the disease cours e, respective ly. Pathergy test was positive in only 11.1% of patients and 11.1% developed neurological involvement. Ocular disease was more common in men and appeared at disease onset (50%) or within the first few years of disease onset (median: 3 years). Only one patient had loss of useful vision in at least one eye at the end of follow-up. 7/10 patients with eye disease were treated with immunosuppressive agents combined with corticosteroids. In all patients affected, visual acuity improved once treatment was started. At the end of follow-up eye disease was in remission in all patients with a median interval from the last ocular inflammatory episode of 4.5 years. Conclusions: This population-based study reported for the first time the prevalence and incidence of BD in Italy. In Italian patients BD is nonfatal and the prognosis of eye disease is good. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Behçet’s disease, epidemiology, uveitis
OP11-05 LONG TERM FOLLOW UP IN POSTERIOR SEGMENT UVEITIS Missotten Tom O. (Dpt Uveitis, Rotterdam Eye Hospital), van Hagen M P (Dpt Immunology, Erasmus MC Rotterdam), van der Loos T (Dpt Internal Medicine, Rotterdam Eye Hospital), Baarsma S G (Dpt Uveitis, Rotterdam Eye Hospital) Introduction : The longterm outcome in idiopathic non-infectious posterior segment uveitis is not well known. Methods : 465 patients who visited the Rotterdam Eye Hospital for their posterior segment uveitis (Idiopathic intermediate uveitis n=185 , Idiopathic panu veitis n=170, p redominant vasculitis n=110) in the period 2005-2006 were compared with well defined uveitis etiologies(n=239) (sarcoid n=154, Behcet n=42 and birds h o t - re t i n o p at hy n=43). Evolution of Visual Acuity, Th e rapy, Inflammatory activity and complications were analysed for the duration of complete follow-up. Results: After a mean follow-up of 7?1 year, visual acuity outcome (individual eyes) at 5 and 10 years for idiopathic intermediate and sarcoid uveitis was 0.8?0.3 and 0.7?0.3 snellen lines respectively. In idiopathic panuveitis, birdshot retinopathy and uveitis with predominant vasculitis visual acuity was 0.6?0.3 and 0.6?0.4 at 5 and 10 years respectively. In the Behcet group outcome was significantly worse : 0.5?0.3 at 5 years and 0.4?0.3 at 10 years. Kaplan-Meyer survival showed a 15% chance of legal blindness of eyes at 20 years of follow-up. (35% of Behcet's eyes). CME was the main parameter correlated with poor visual outcome. There was an CME incidence (per year) of between 8% and 18% according to disease group and a cumulative CME incidence (at 10 years) of 43%. In 80% of patients there was a significant difference in activity between the 0-5 year and 5-10 year follow-up periods. Conclusion: Long term outcome analysis emphasised the importance of macular edema follow-up in severe posterior segment uveitis. In the chronic phase of the disease, a VA of <0.6 snellen is a warning sign for inadequate therapy or an untreated complication (CME, cataract, glaucoma) Financial fundings: No funding Conflict of interest: No conflict of interest Keywords: Epidemiology, Non-infectious Uveitis
OP11-06 DURATION AND SEVERITY OF OCULAR SARCOIDOSIS IN JAPAN Namba Kenichi (Department of Ophthalmology and Visual Sciences, Hokkaido Unive rsity Gra d u ate School of Medicine, Sapporo, Japan), Goda Chiho (Department of Ophthalmology and Visual Sciences, Hokkaido Unive rsity Gra d u ate School of Medicine, Sapporo, Japan), Kitaichi Nobuyoshi (Department of Ophthalmology and Visual Sciences, Hokkaido Unive rs i t y Graduate School of Medicine, Sapporo, Japan), Kitamura Mizuki (Department of Ophthalmology and Visual Sciences, Hokkaido Unive rsity Gra d u ate School of Medicine, Sapporo, Japan), Takemoto Yu ko (Dep a rtment of Ophthalmology and Visual Sciences, Hokkaido Unive rsity Gra d u ate School of Medicine, Sapporo, Japan), Ohno Shigeaki (Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan) Purpose: Sarcoidosis has been increasing in Japan, and is one of the most frequent causes of intraocular inflammation (II). In this
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Abstract Book study, we examined the duration and severity of II and the ratio of refractory cases to the medication. Methods: Ninety-four tissue proven sarcoidosis patients with II were examined retrospectively. We defined the patients with more than 6 months duration of II as prolonged case. We defined the patients with following findings as severe case; diffuse vitreous opacity ?3+, cystoid macular edema, optic disc gra nu l o m a , choroidal granuloma, epimacular membrane larger than 3 disc diameters, retinal neovascularization, secondary glaucoma with visual field loss, iris bombe, iris nodule larger than 4mm and retinal detachment. Patients requiring following medications were defined as refractory cases; systemic prednisolone ?20mg over 3 months, intravitreal injection of triamcinolone acetonide (TA), repeated sub-Tenon?s injection of TA, glaucoma filtering surgery, vitrectomy and scleral buckling. Results: 37.2% of the patients belonged to prolonged case. 45.7% of the patients were classified as severe case. 34% of the cases were refractory cases. Visual prognosis was poor with less than 0.1 of visual acuity in 6.9% of the patients. Conclusions: Although II in sarcoidosis shows good response to the treatment such as systemic corticosteroids, prolonged inflammation can cause severe complications in the eye and lead to poor visual prognosis. Financial fundings: (None.) Conflict of interest : (None.) Keywords: sarcoidosis, duration, severity
OP11-07 SECONDARY GLAUCOMA IN UVEITIC PATIENTS: SIX YEARS EXPERIENCE OF T WO ITALIAN REFERRAL CENTERS. Pia Allegri (Lav agna Hospital Ophthalmological Department (Genova - Italy)) Luca Cimino (S. Maria Nuova Hospital Ophthalmological Unit (Reggio Emilia - Italy)), Ugo Murialdo (Lavagna Hospital Ophthalmological Department (Genova Italy)), Luca Cappuccini (S. Maria Nuova Hospital Ophthalmological Unit (Reggio Emilia - Italy ) ) , Antonio Mastromarino (Lavagna Hospital Ophthalmological Department (Genova - Italy)) PURPOSE: Assessment of the incidence and the clinical characteristics of secondary glaucoma (SG) in patients affected by different inflammatory eye diseases and description of its management and outcome in a period of 6 years (Jan. 2000 - Dec. 2006) in two referral uveitis Italian centers (Lavagna and Reggio Emilia). The evaluation was made by reviewing the files of uveitic patients hospital records. RESULTS: 87 out of 978 patients ( 8.9 %) with uveitis suffered from some forms of SG. Anterior uveitis had the higher prevalence of SG (67.8%); but the disease was also present in posterior uveitis (12.6%) and intermediate uveitis (8%); the remaining percentage (11.6%) of eyes was of different not well classified overlapping forms. In our experience, Fuch’s uveitis is the prevalent (30%) association with SG, followed in order of prevalence, by Herpetic (HSV and VZV) uveitis (23%), JRA (19.5%), Sarcoidosis (11.5%), Tb (10.3 %), Possner-Schlossmann Syndrome (5.7%). Medical therapy, if aggressive, was able to contro l , without progre ssion of visual field defects, o n ly 63.3% of our SG pat i e n t s . 23% were controlled by filtering surgery (9 eyes underwent Baerweldt, Molteno or, more recently, Ex-press dra i n age implantation).
The remaining eyes (13.7%) underwent, despite medical and surgical management, a progressive visual field loss, until optic glaucomatous atrophy. CONCLUSIONS: Our experience points out that ophthalmologists should pay attention to an underappreciated complication of uveitis, secondary glaucoma, that, if treated at an early stage and in a more aggressive manner, may preserve vision and visual field in a high number of uveitic patients. Financial fundings: No funds financing this research Conflict of interest : No conflict of interests of the Authors Keywords: Secondary glaucoma, uveitis, epidemiology
OP11-08 RESPECTIVE ROLES OF CONGENITAL AND ACQUIRED INFECTION IN OCULAR TOXOPLASMOSIS Brézin Antoine P (Hopital Cochin), Delair Emmanuelle (Hopital Cochin), Monnet Dominique (Hopital Cochin), Brézin P Antoine (Hopital Cochin) Introduction:To analyze the roles of acquired or congenital infections in cases of ocular toxoplasmosis, and to compare their clinical manifestations Methods: Retrospective, observational case series. We analyzed the charts of consecutive patients with a diagnosis of ocular toxoplasmosis. Data from the French program for prevention of congenital toxoplasmosis was used to assess the origin of infection. The data included patients’ serological status prior to their ocular manifestations and patients’ mothers serological status before, during, and/or after pregnancy. Infections were categorized as congenital, acquired, or unknown. Results: Of 425 cases of ocular toxoplasmosis, 100 (23.5 %) were acquired, 62 (14.6 %) were congenital, and 263 (61.9 %) were of unknown origin. At the time of the study, the mean age of patients with congenital ocular toxoplasmosis was 9.1 +/- 8.8 years, and was 21.7 +/- 12.6 years in patients with acquired ocular toxoplasmosis (p < 0.0001). Bilateral chorioretinitis was observed in 4 % of acquired cases and in 43.5 % of congenital cases (p < 0.0001). In acquired infection, mean decimal visual acuity was 1.0 (logMAR 0.0 +/- 1 line) in the best eye and 0.4 (logMAR 0.4 +/- 5 lines) in the worst eye. In congenital cases, mean decimal visual acuity was 0.8 (logMAR 0.1 +/- 4 lines) in the best eye and 0.25 (logMAR 0.6 +/- 7 lines) in the worst eye (p < 0.05). Conclusion: In cases where the origin of the infection could be determined, acquired infection were a more frequent cause of ocular toxoplasmosis than congenital cases. Congenital ocular toxoplasmosis was more severe than acquired cases. Financial fundings: None Conflict of interest: None Keywords: Ocular Toxoplasmosis, congenital, acquired
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Abstract Book RF1-1 HIGH PREVALENCE OF ACTIVE POSTERIOR SEGMENT LESIONS IN NEWBORNS WITH CONGENITAL TOXOPLASMOSIS IDENTIFIED BY NEONATAL SCREENING PROGRAM IN MINAS GERAIS, BRAZIL Vasconcelos-Santos Daniel V (Federal University of Minas Gerais, Brazil) Campos R Wesley (Federal University of Minas Gerais, Brazil), Oréfice Fernando (Federal University of Minas Gerais, Brazil), Machado Carellos V Ericka (Federal University of Minas Gerais, Brazil), Queiroz de A n d rade M Gláucia (Fe d e ra l University of Minas Gerais, Brazil), Januário N José (Federal University of Minas Gerais, Brazil) Introduction and objectives: Evidence on higher prevalence and morbidity of toxoplasmosis in South America is compatible with recent identification of more virulent strains in this area, where the impact of congenital disease is barely understood. This paper’s aim was to evaluate ophthalmological involvement in newborns with congenital toxoplasmosis (CT) identified by neonatal screening in Minas Gerais (MG), Brazil. Methods: Prospective study of children with CT identified by newborn screening (IgM anti-Toxoplasma gondii, Q-Preven) in MG, from November 2006 to March 2007. Confirmatory serology was performed and newborns presenting IgM and/or IgA and IgG, or IgG associated with ocular lesions and IgM and IgG in the mother were considered positive. Indirect binocular ophthalmoscopy and fundus photographs were accomplished. Besides paediatrician, radiologic and audiologic ex a m i n at i o n s , d e t e rm i n ation of mother/baby immunological profile and isolation and typing of toxoplasma strains from peripheral blood are in progress. Results: A total of 107,180 children were tested, accounting for 98% of live births in MG, in the studied period. Ninety-six were positive, leading to an incidence of 1:1,116. Initial ophthalmological examination was performed at an average age of 46.0+/-12.8 days (median: 43 days). Retinochoroiditis lesions compatible with CT were detected in 69/96 (71.8%). Among these 69 infants, active lesions in at least one eye were disclosed in 43 (62.3%), bilateral lesions in 43 (62.3%) and macular involvement in 53 (76.8%). Associated findings such as vasculitis, vitreous opacities and tractional retinal detachment could be observed in respectively 18.8% (13/69), 13.0% (9/69) and 1.5% (1/69). Conclusion: High prevalence of active retinochoroiditis in newborns with CT in MG was observed. Possible role of more virulent T. gondii strains and of variable host immune status is being currently investigated. Financial fundings: Secretaria do Estado da Saúde de Minas Gerais, Brazil Conflict of interest : No conflicts of interest Key wo rds: c o n genital tox o p l a s m o s i s , a c t ive re t i n o ch o roiditis, neonatal screening
RF1-2 CLINICAL FEATURES, RISK FACTORS AND COMPLICATIONS OF UVEITIS IN JUVENILE IDIOPATHIC ARTHRITIS K a d ayifcilar Sibel, (Hacettepe Unive rs i t y ) , E rdo an Cere n (Hacettepe University), Özen Seza (Hacettepe University), Eldem Bora (Hacettepe University), ‹rkeç Murat (Hacettepe University) Purpose: To evaluate the clinical features and to determine the risk factors and rate of complications in patients with juvenile idiopath9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 79
Abstract Book ic arthritis (JIA)associated uveitis. Methods: Ninety-five patients with JIA were evaluated prospectively between October 2005 and March 2007. The age, sex, the age at the diagnosis of JIA, subtype of JIA, antinuclear antibody positivity, rheumatoid factor titers, the age at the diagnosis of uveitis, and complications from uveitis were recorded. Results: Eight children had active uveitis at the initial ocular examination and 25 more developed uveitis during the follow-up. Twenty-eight of the patients with uveitis were girls. Of these 33 (34.7%) patients with uveitis, 25 (75.7%) had oligoarticular and 8 (24.3%) had polyarticular type; none had systemic-onset JIA. When all patients were assessed, 62 (65.2%) were oligoarticular, 25 (26.3%) were polyarticular and 8 were systemic-onset (8.5%). The prevalence of uveitis was significantly higher in patients with oligoarticular JIA. The mean age at the onset of arthritis in the patients with uveitis was 3.31 years, which was significantly lower than in the non-uveitis group (5.1 years). Antinuclear antibody (ANA) was positive in 29 (87.8%) of the 33 uveitis patients, confirming ANA as a significant determinant for uveitis in JIA. Uveitis was bilateral in 2 of 33 patients (6.1%). Ten (30.3%) of the 33 patients developed serious sight-threatening complications like band keratopathy, cataract and glaucoma during the follow-up period. Rheumatoid factor was positive in 13 patients and was not found to be related with uveitis. The family history was positive only in 4 patients. Conclusions: This study confirmed that oligoarticular onset, ANA positivity, female gender and young age are risk factors for developing uveitis in patients with JIA. Rheumatoid factor was not found to be a risk factor. Financial fundings: None Conflict of interest : None Keywords: uveitis, juvenile idiopathic arthritis, antinuclear antibody
RF1-3 OUTCOME AND COMPLICATIONS OF PEDIATRIC AND JUVENILE UVEITIS YÜCE Berna (Ege University School of Medicine Ophthalmology Clinic), KÖSE N Süheyla (Ege University School of Medicine Ophthalmology Clinic), ÜRETMEN Önder (Ege University School of Medicine Ophthalmology Clinic) ATEfi Halil (Ege University School of Medicine Ophthalmology Clinic), Yald›z Helin (Ege University School of Medicine Ophthalmology Clinic) Purpose: To determine the etiology, clinical course, outcomes of medical treatment and complications of pediatric and juvenile uveitis. Methods: We retrospectively reviewed the medical charts of 65 eyes of 44 patients, who had been followed up at Ege University School of Medicine Ophthalmology Clinic Uveitis Unit. Etiological entities, clinical course and characteristics, complications and the outcome of medical treatment are noted. Results: Mean age at the diagnosis was 12.8 years ( range: 3-18. The uveitis was idiopathic in 61.6 % of the cases. The most commonly identified entities included juvenile rheumatoid arthritis, Behçet’s Disease, i n fe c t i o n s , immunglobulin defi c i e n cy and leukemia. Localisation of uveitis was anterior in 30 cases, intermediate in 4 cases, posterior in 3 cases, total in 7 cases. Complications occurred in 10 cases. The most commonly developed complications
were glaucoma( 4 cases) and cataract(4 cases. The evolution of visual acuity was favorable in most cases. Visual acuity was better than 0.5 in 73 % cases, between 0.1-0.5 in 22 % cases; worst than 0.1 in only 5 % cases at the last visit. 23 patients underwent local; 21 patients underwent local and systemic treatment. During the follow up period 3 patients underwent cataract surgery, 1 patient had retinal detachment surgery and 1 patient had vitrectomy. Conclusion: Uveitis in pediatric and juvenile patients are mostly idiopatic. The most commonly identified entities included; juvenile rheumatoid arthritis, Behçet’s Disease and infections in our country. The final outcome was favorable with local treatment and systemic prednisolone, azathioprine, metotrexate, cyclosporin treatment. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Pediatric uveitis, ocular complications, treatment
RF1-4 RETROSPECTIVE STUDY OF 111 PATIENTS WITH HERPETIC ANTERIOR UVEITIS Otuk Berna M. (Istanbul University Istanbul Faculty of Medicine, Ophthalmology Department) Altinkurt Emre (Istanbul University Istanbul Faculty of Medicine, Ophthalmology Department), TugalTutkun Ilknur (Istanbul University Istanbul Faculty of Medicine, Ophthalmology Department) Introduction and objectives: To describe the clinical features and outcomes in patients with herpetic anterior uveitis Methods: A retrospective study of 111 patients with herpetic anterior uveitis diagnosed clinically at the Department of Ophthalmology, Istanbul Faculty of Medicine, from January 1996 to December 2006. When present, herpetic corneal disease and active or past episode of herpes zoster ophthalmicus were considered diagnostic of herpetic anterior uveitis. In patients without corneal involvement, the diagnosis was based on the presence of at least three of the following features: recurrent unilateral attacks in the same eye, granulomatous keratic precipitates, patchy or sectoral iris atrophy and/or transillumination defects, distorted pupil, and acute elevation of intraocular pre s s u re during infl a m m at o ry episodes. Results: Fifty patients were male, 61 were female. Mean age at onset of uveitis was 39.2 (5-74) years. Three atopic patients had bilateral involvement. Twelve patients had active or a past episode of herpes zoster ophthalmicus. Ocular findings were granulamatous anterior uveitis (96.3%), active keratitis or corneal scars (57%), elevated intraocular pressure (50.8%), iris atrophy and/or translummination defect (48.2%), distorted pupil (25.4%), and posterior synechiae (26.3%). The recurrence rate was 0.45 / person year. In 49 eyes (43%) there was no corneal scar or active keratitis during follow-up period. Topical corticosteroid and oral antiviral therapy were administered to all patients during active episodes. Oral corticosteroid therapy was administered to 21.6% of the patients. Final visual acuity was worse than 0.5 in 16.6% of the involved eyes and was due to corneal scarring and cataract formation. The patients with only iridocyclitis had no permanent visual loss. No patient had any posterior pole complication. Two patients had secondary glaucoma. Conclusions: Herpetic anterior uveitis is a distinct entity that can be diagnosed clinically. Although the recurrence rate is high, visual outcome is favorable in most cases. Financial fundings: (None.)
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 80
Abstract Book tectable. Conclusions: Tacrolimus ointment 0.03% appears to be safe, well tolerated, and effective in the treatment of allergic conjunctivitis refractory to traditional treatments.
Conflict of interest : (None.) Keywords: herpetic, anterior, uveitis RF1-5 DETECTION OF INTRAOCULAR ANTIBODY SYNTHESIS IN FUCHS’ HETEROCHROMIC CYCLITIS (FHC) Ruokonen Peter C (Charité eye hospital CVK, Berlin), Metzner Silvia , Torun Necip (Charité eye hospital CVK, Berlin), Pleyer Uwe (Charité eye hospital CVK, Berlin)
Financial fundings: (None.) Conflict of interest : (None.) Keywords: Tacrolimus, Allergic, Conjunctivitis
RF1-7 Introduction and objectives: FHC is a common intraocular disease of uncertain etiology. Recently, Rubella Virus was proposed to be one possible cause. Methods: We analysed the avidity of Rubella-specific IgG in aqueous humor and serum samples in 27 patients FHC. 17 samples were analysed retrospectively whereas 10 samples were investigated prospectively. Results: Specific intraocular antibody synthesis could be confirmed in 26 patients. In one individual, neither Rubella-specific IgG, nor HSV-, VZV- or CMV-specific antibodies, could be detected. Interestingly, in 7 patients with positive Rubella virus IgG synthesis, additional HSV (n=7), VZV (n=1) and CMV (n=1) specific antibodies could be detected. Conclusions: FHC is strongly associated with intraocular antibody synthesis against Rubella Virus. However, in 7 patients, an additional intraocular antibody synthesis, in particular HSV, could be confirmed. Cross-reactions, coincidence or false-positive results have to be considered. Financial fundings: none Conflict of interest : none Keywords: Heterochromic Cyclitis Fuchs', Rubella virus, intraocular antibody synthesis
RF1-6 TOPICAL TAC ROLIMUS 0.03% OINTMENT FOR INTRACTABLE ALLERGIC CONJUNCTIVITIS: AN OPEN LABEL PILOT STUDY Benyamini Oren G (Assaf Harofe Medical Center), Attas-Fox Liat (Assaf Harofe Medical Center), Morad Yair (assaf Harofe Medical Center), Avni Isaac (assaf Harofe Medical Center), Zadok David (assaf Harofe Medical Center) Objectives: To determine the efficacy, tolerance and safety of tacrolimus 0.03% ointment in the treatment of intractable allergic conjunctivitis. Methods: 20 patients (mean age 10.8 years: range 6-26) with intractable allergic conjunctivitis were treated in an open-label study. Patients received topical 0.03% tacrolimus ointment alone, twice daily for 8 weeks and were followed for 2 weeks after stopping the study drug. Full eye examinations were conducted weekly. Objective symptoms of chemosis, tarsal follicle size, corneal staining and subjective symptoms of tearing, itching and photophobia were recorded (as per modified scoring system of Abelson). We measured tacrolimus levels after two weeks of treatment. Results: Marked clinical improvement in the modified Abelson score was observed over the 8 weeks of treatment, in all categories (p<0.001). In addition we noted marked improvement in visual acuity in some of the patients. Adverse events were limited to local burning in one patient that discontinued treatment. No clinical immunosuppression occurred. Tacrolimus 0.03% levels were unde-
CLINICO-MICROBIOLOGICAL REVIEW OF POLY M ICROBIAL ENDOPHTHALMITIS IN A TERTIARY EYE CARE CENTRE IN SOUTH INDIA. Pat h e n gay Avinash (Vi s a k h ap atnam LV Prasad eye institute), Morekar Mayur (L V Prasad eye institute), S h a rma Sav i t ri (Bhubaneswar L V Prasad eye institute), Das Ta rap ra s a d (Bhubaneswar L V Prasad eye institute) Purpose: To determine the prevalence, causative organisms and visual outcome in patients with culture proven polymicrobial endophthalmitis. Methods: A retrospective chart review of patients with culture proven endophthalmitis diagnosed between January 2000 and December 2004 at a tertiary eye care centre in south India was done. All patients were uniformly treated as per the institutional guidelines. Microbiological work-up of the vitreous aspirates consisted of microscopy, culture and antibiotic sensitivity. Isolation of two or more types of organisms from vitreous was considered polymicrobial infection. The best corrected visual acuity of < 20/200 at final follow-up was defined as a poor visual outcome. Results: Polymicrobial endophthalmitis was seen in 20 (4 %) of 498 patients of culture proven endophthalmitis yielding 40 isolates. Nineteen (95%) of 20 vitreous samples yielded gram-positive bacteria and one sample yielded a fungus as the first organism in combination with other organisms. The second organism was grampositive bacteria (9; 45%), gram-negative bacteria (5; 25%) and a fungus in 6 (30 %) of the vitreous samples. Staphylococcus epidermidis was the commonest gra m - p o s i t ive bacteria (12; 60%). Fourteen (70%) of 20 cases were post-traumatic endophthalmitis and six cases were postoperative endophthalmitis. Twelve (86%) of post-traumatic endophthalmitis and two of postoperative endophthalmitis had a poor visual outcome. Conclusions: Polymicrobial endophthalmitis is rare and is more often associated with trauma and poor visual outcome. Financial fundings: nil Conflict of interest : nil Keywords: polymicrobial, endophthalmitis, South india
RF1-9 F L U O RO D E OXYGLUCOSE POSITRON EMISSION TOMOGRAPHY FOR THE DIAGNOSIS OF SUSPECTED UVEITIS-ASSOCIATED SARCOIDOSIS IN PATIENTS WITH NORMAL CHEST COMPUTERIZED TOMOGRAPHY Séve pascal (Hospices Civils de Lyon, University Claude bernard Lyon 1, Lyon, France) Billotey Claire (Hospices Civils de Lyon, University Claude bernard Lyon 1, Lyon, France), Janier Marc (Hospices Civils de Lyon, University Claude bernard Lyon 1, Lyon, France), Grange Jean-Daniel (Hospices Civils de Lyon, University Claude bernard Lyon 1, Lyon, France), Broussolle Christiane
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 81
Abstract Book (Hospices Civils de Lyon, University Claude bernard Lyon 1, Lyon, France), Kodjikian Laurent (Hospices Civils de Lyon, University Claude bernard Lyon 1, Lyon, France) Introduction and Objectives: In case of a normal high-resolution chest computeri zed tomography (CT) or in the absence of histopat h o l ogic confi rm at i o n , suspected uve i t i s - a s s o c i ated sarcoidosis may be diagnosed non-invasively by serum angiotensin converting enzyme assay, bronchoalveolar lavage, and 67Gallium citrate scintigraphy. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a functional imaging technique that appears to outperform 67Gallium scintigraphy for the diagnosis of sarcoidosis. We report the usefulness of FDG-PET for the diagnosis of suspected uveitis-associated sarcoidosis in patients with normal chest CT. Methods: A retrospective study of our complete experience using FDG-PET for the diagnosis of suspected uveitis-associated sarcoidosis was conducted. Ten patients (8 females, 2 male) with uveitis and suspected associated sarcoidosis were reviewed. These patients presented with either ophthalmic or clinical findings suggestive of uveitis-associated sarcoidosis (4 patients) or indeterminate sarcoid uveitis (6 patients). The main outcome measure was to assess the sensitivity 18F-FDG-PET for the diagnosis of sarcoidosis. Results: 18F-FDG-PET showed either mediastinal and/or lachrymal uptake in 5 patients with indeterminate sarcoid uveitis and in 3 patients with ophthalmic or clinical findings suggestive of uveitisassociated sarcoidosis. 67Gallium scintigraphy was performed in 7 patients and showed accumulation either in the hilum of the lungs or in the lachrymal glands in four cases. Subsequent mediastinal biopsy revealed granulomatous lesions in two patients. Conclusions: In this small series, 18F-FDG-PET showed focal uptake suggestive of sarcoidosis in most of the patients and appeared to be more accurate than 67Gallium scintigraphy. Financial fundings: (None.) Conflict of interest : (None.) Keywords: sarcoidosis, F l u o ro d e oxyglucose positron emission tomography, Gallium scintigraphy
RF1-12 EVALUATION OF KERATIC PRECIPITATES WITH IN VIVO CONFOCAL MICROSCOPY Kaday›fç›lar Sibel (Hacettepe University), Mocan Cem (Hacettepe University), ‹rkeç Murat (Hacettepe University ) Introduction and objectives: To evaluate the morphology of keratic precipitates (KP) with in vivo confocal microscopy (IVCM) in uveitis of various etiologies. Methods: The corneas of 54 subjects (20 females, 34 males) with uveitis were evaluated with in vivo confocal micro s c o py (Confoscan 3.0, Vigonza, Italy). The etiology, anatomic localization of the intraocular inflammation and the slit-lamp characteristics of the KPs were noted for each patient. KPs were categorized into five subtypes based on their appearance with IVCM as follows: Large, smooth-rounded (Type I), small and round (Type II), conglomerate containing multiple hyperreflective dots (Type III), dendiritiform (Type IV) and stippled (Type V). If more than one KP type was detected in a cornea, both the predominant and the second frequently observed type were documented. Results: The ages of the patients ranged between 11 and 66 years (mean=39.0±14.0 years). Thirty-six patients had inflammation in the anterior segment only. The predominant KP in patients with
Behçet’s disease (n=16) was type II (100%), in ankylosing spondylitis (n=12) type V (50%) followed by type IV (25%), in Fuchs heterochromic uveitis (n=6) type IV (67%) followed by Type V (33%),in granulomatous uveitis (n=6) type III (50%) followed by type I (33%), in infectious uveitis (n=3) type II (66%) followed by type IV(33%), in juvenile idiopathic arthritis (n=2) type II (100%) and in idiopathic uveitis type IV (44%). More than one KP type was observed in thirty-one (57%) corneas. Conclusions: Certain KP types as imaged with IVCM appear to be more closely related to specific uveitis syndromes. IVCM may have a potential role in the differential diagnosis of various uveitis entities when used in conjunction with clinical findings. Financial fundings: None Conflict of interest : None Keywords: Keratic precipitate, confocal microscopy, uveitis
RF1-13 NEW MANAGEMENT OF DRY EYE IN OCULAR INFLAMMATIONS. Mannucci Lorenzo L. (Department of Ophthalmology-University of Padua-Italy), Boldrini Enrico (Opocrin Pharmaceutics -Modena-I taly), Falcone Giulia (Opocrin Pharmaceutics - Modena - Italy) Aim: To evaluate new prospects in the management of dry eye in ocular inflammations with two new polysaccharidic compounds. Materials and methods: 1) arabinogalactan (acronym AG) is a natural polysaccharide from larch tree. Bioadhesion in vitro, precorneal residence time in rabbits and re-epithelisation speed of corneal ulcers in albino rabbits were measured. 2) tamarind seed polysaccharide (acronym TSP) is a "branchedchain" polysaccharide, extracted from tamarind gum. Precorneal residence time and ferning properties were respectively evaluated in rabbits and in vitro. Results: 1) In spite of newtonian non-viscous behaviour (n = 1.6 mPa.s for 10% w/w solution), AG precorneal residence was evident up to 60 minutes after instillation. The re-epithelisation speed of rabbit ulcers was more rapid with AG treatment (44 hrs.) in comparison to the controls ( 60 hrs. and longer). 2) TSP 0.5% solution showed a long precorneal permanence (8 hours); its ferning test was very similar to the natural mucin. Conclusions: 1) The long residence time of AG derives from its high mucoadesive properties (delta n/n 17.21) as compared to hyaluronic acid (delta n/n 3.02). Moreover AG performed favorably in the re-epithelisation of experimental corneal ulcers. 2) Among viscoelastic marketed lach rymal substitutes, only branched-chain polysaccharides (TSP) have got a chemical structure similar to transmembrane mucins (as MUC I); ferning test "type 1" confirmed "mucin like" properties. Summarizing, the two compounds have opposite characteristics and different indications. TSP, as mucomimetic, is recommended in ocular inflammations when mucous layer is absent; AG, as mucoadhesive, is indicated when mucous layer is altered, but not greatly reduced. For these reasons, an exact diagnosis of the mucous layer is fundamental for opportune therapy. Financial fundings: (None.) Conflict of interest : (None.) Keywords: dry eye, arabinogalactan, tamarind seed polysaccharide
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Abstract Book RF1-14 NONALLERGIC EOSINOPHILIC CONJUNCTIVITIS K. Matti Saari, Osmo Kari and Tari Haahtela Department of Ophthalmology, University of Turku, Turku and Departments of Ophthalmology and Allergology, University of Helsinki, Helsinki, Finland Introduction and objectives: The aim of this pa per was to d e s c ribe the clinical characteristics, amount of conjunctiva l eosinophils and group IIA phospholipase A2 (GIIAPLA2) content of tears in patients with nonallergic eosinophilic conjunctivitis (NAEC), and compare the findings with those of normal controls and patients with atopic conjunctivitis (AC). Methods: We studied the clinical characteristics, conjunctival eosinophils in biopsy specimens after staining with eosinophilic specific monoclonal antibodies EG1 and EG2, and the content of GIIPLA2 in tears determined by a time-resolved fluoroimmunoassay in 27 patients with NAEC. Results: The patients with NAEC complained itching, tearing, redness, foreign body sensation and mild discharge. They showed noninfectious conjunctivitis with at least 1+ eosinophilia (semiquantitative scale from 1+ to 4+) in conjunctival brush cytology, negative skin prick tests and no allergen-specific serum immunoglobulin E antibodies to common environmental allergens. The number of EG1/EG2 positive eosinophils was significantly higher in conjunctival biopsies of patients with AC than in those with NAEC (p=0.04). The GIIAPLA2 concentration of tears was decreased in patients with AC but it was normal in patients with NAEC when compared with age-matched normal controls. Conclusions: Negative skin prick tests and negative allergen-specific serum immunoglobulin E antibodies to common environmental allergens in patients with NAEC and the higher number of EG1/EG2 positive eosinophils in AC than in NAEC and decreased GIIAPLA2 content of tears in patients with AC and normal GIIAPLA2 content of tears in patients with NAEC support the theory that NAEC is a disease entity separate from the group of allergic conjunctivitis. Financial fundings: The Research Fund of the Turku University Central Hospital, VSSHP, Turku, Finland Conflict of interest: (None.) Keywords: Conjunctivitis, cytology, eosinophils
RF1-15 DLK (DIFFUSE LAMELLAR KERATITIS) â&#x20AC;&#x201C; A NEW CLASSIFICATION Wender Ariel (Dr. Wender Laser Clinic) Introduction and objectives: To suggest a new classification for DLK that takes in consideration the extent of the inflammation as well as its intensity. The classification helps to make the right treatment decision to preserve VA and avoid stage 4 DLK. Methods: During the years 2003- 2006, we had three epidemics of DLK that last between one week and two weeks. More than 60 patients suffered from different degrees of DLK. Twenty-two of this patient needed irrigation of the inflammatory cells in the interface. Affected patients were treated according the classification that takes into consideration the extent of the inflammation as well as its intensity. All treatments were done by a single surgeon (AW), in the same operation setting. In the follow-up period visual acuity was registered, and inflammation was graded, corneal topographies were
acquired. Slit-lamp corneal pictures were taken in some of the patients. Results: Using this classification, all patients were treated successfully. None of the patient suffered grade 4 DLK. All patients except one achieved preoperative BCVA better. One patient suffered loss of one line in one eye due to striae. Conclusion: DLK is a self-limited inflammation that may leave visual impairment. Most of the cases are epidemic and many times with very severe cellular infiltration. The classification suggested makes the predictability of outcome easier, helps to avoid progress to stage four, and preserve excellent VA. Financial fundings: The author has no financial interest in any of the products used or mentioned for this presentation Conflict of interest : The author has no potential conflict in any of mentioned for this presentation Keywords: DLK, Lasik, Complications
RF1-16 SHORT AND LONG TERM OUTCOMES OF AMNIOTIC MEMBRANE GRAFTING IN ACUTE CORNEAL BURNS Tannen Bradford L (UMDNJ -- New Jersey Medical School) Chu S David (UMDNJ -New Jersey Medical School) Introduction: Burn injuries produce extensive damage to the ocular surface. Recent reports suggest amniotic membrane grafting (AMG) facilitates epithelialization, and reduces inflammation, vascularization, and scarring when used for acute corneal burns. Purpose: This study was designed to investigate our short and long-term outcomes with AMG for acute corneal burns. Methods: Retrospective review identified 8 eyes of 6 patients who underwent AMGs for acute corneal burns. Outcome measures included short and long-term visual acuity, time to epithelialization, symptomatic relief, symblepharon formation, and corneal vascularization. Our results were compared both with recently-published reports of AMG from other centers and with reports of medical management alone for corneal burn injuries. Results: All patients were men (Avg age 43.2). 3 eyes had grade II, 1 eye had a grade III, and 4 eyes had grade IV burns based on Roper-Hall criteria. 10 AMGs were performed in the acute setting (Avg 7.3 days after injury). Epithelial defects healed in 36.5 days. Faster re - epithlialization occurred with Grade II burns. Symptomatic pain relief was noted in all. Symblepharon formed only in 2 of the 4 patients with grade IV burns. Corneal vascularization formed to some degree in 6 out of 8 eyes. Short term visual improvement was 4.1 lines, improving to 7.4 lines in the long term (Avg follow up 28 months). Stabilization of the corneal surface was achieved in all eyes. Conclusions: AMG appears to be superior in all outcome measures to medical management alone in the treatment of acute corneal burns. Our short-term results are consistent with recently-published reports of AMG. In addition, our long-term results suggest the use of AMG may play a role in stabilizing the corneal surface in grade IV burns, as well as grade II and III burns. Financial fundings: None Conflict of interest : None Keywords: cornea, burns, amniotic membrane
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Abstract Book RF1-17 COMPARISION OF SAFETY AND EFFICACY OF DIFFERENT METHODS OF POSTERIOR SUB-TENON INJECTION Kumar Chandra Shekhar (Dr. RP Centre for ophthalmic sciences, AIIMS, New Delhi, India) Venkatesh Pradeep (Dr. RP Centre for ophthalmic sciences, AIIMS, New Delhi, India) Abbas Zahir (Dr. RP Centre for ophthalmic sciences, AIIMS, New Delhi, India) Garg Satpal (Dr. RP Centre for ophthalmic sciences, AIIMS, New Delhi, India) Introduction and objectives: A prospective comparative randomized interventional study was done to compare the safety and efficacy of different methods of Posterior sub-tenon (PST) injection of corticosteroids in the treatment of cystoid macular edema secondary to intermediate uveitis. Methods: Patients were randomized into three treatment groups of 10 eyes each. Each group received PST injection of triamcinolone acetonide 0.5 ml (20 mg) by one of three methods: Cannula method (Group 1), Smith and Nozik method (Group 2) and Orbital floor injection method (Group 3). Patients underwent Snellen’s and ETDRS visual acuity (VA) testing, clinical evaluation, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) at baseline and follow up visits. Results: Post intervention patients were followed up at 1st, 2nd, 6th and 12th week. Statistically significant (p=0.00) improvement in VA were present in group1 from 0.25 ± 0.08 (mean ± standard deviation) to 0.75 ± 0.24, in group 2 from 0.29 ± 0.12 to 0.78 ± 0.23 and in group 3 from 0.24 ± 0.10 to 0.72 ± 0.27 and no statistical difference (p>0.05) was noted in mean visual acuity at each visit between different groups. Statistically significant decrease in OCT central macular thickness (43.97 % in group 1, 32.46 % in group 2 and 29.75 % in group 3) were noted at 12 weeks. However the difference between individual groups at each visit did not reach statistical significance. Steroid induced rise in intraocular pressure was observed in all the three groups with no statistical difference between individual groups. Conclusions: The different methods of PST injection are equally efficacious. The Cannula method may be preferred in place of commonly used Smith and Nozik method as it is safer. Financial fundings: Nil Conflict of interest : Nil Key wo rds: SAFETY, EFFICACY, POSTERIOR SUB-TENON INJECTION
RF1-18 EFFECT OF 0.03% TACROLIMUS OINTMENT ON CONJUNCTIVAL CYTOLOGY IN ATOPIC BLEPHAROCONJUNCTIVITIS Osmo Kari, Hannele Virtanen, Sakari Reitamo, Marjatta Kari and K. Matti Saari Departments of Ophthalmology, Allergology and Dermatology, University of Helsinki, Helsinki and Department of Ophthalmology, University of Turku, Turku, Finland Introduction and objective s : Ta c ro l i mus ointment inhibits i n fl a m m at o ry cytokine re l e a s e, p revents T-cell activation and downregulates the high-affinity IgE receptor (FcRI) expression on Langerhans cells. The aim of this study was to evaluate the effect of tacrolimus ointment on conjunctival cytology in patients with
atopic blepharoconjunctivitis. Methods: Ten patients with severe atopic blepharoconjunctivitis treated with 0.03% tacrolimus ointment once daily as an intermittent treatment were analysed retrospectively. The main outcome measures were clinical response to topical tacrolimus, adverse events and changes in the inflammatory cells obtained from the conjunctival brush cytology samples. Results: Marked clinical response in symptoms was seen after a mean follow-up of six weeks. Clinical scores decreased by 67% in blepharitis and 74% in conjunctivitis symptoms. No severe adve rse events or signs of immunosuppression such as herpes simplex infection occurred. No significant changes occurred in visual acuity, refraction, anterior chamber, retina or intraocular pressure. Median decreases were 85% (p=0.01) in conjunctival eosinophils, 50% (p=0.01) in neutrophils and 58% (p=0.02) in lymphocytes. Conclusions: Tacrolimus ointment is potentially a safe and effective treatment for atopic blepharoconjunctivitis. Regular treatment of the eyelids once daily may lead to clinical and cytological improvement of the conjunctivitis. Financial fundings: No Conflict of interest : No Key wo rd s : OCULAR PHARMAC O L O G Y, TAC ROLIMUS OINTMENT, BLEPHAROCONJUNCTIVITIS
RF1-19 IN VITRO MICROBIOLOGICAL EFFICACY OF NEWLY DESIGNED VANCOMYCIN BASED MICROPARTICLES IN ENDOPHTHALMITIS PROPHYLAXIS LEE Miyeon (LAGEP), HACHICHA Walid (LAGEP), FESSI Hatem (LAGEP), KODJIKIAN Laurent (LBMR) Objectives: To assess in vitro bactericidal and anti-adhesion properties of vancomycin microparticles compared to lyophilized vancomycin, to estimate their relevance to perioperative antibiotic prophylaxis and endophthalmitis prevention. Methods: Lyophilized vancomycin at 20 Ìg/mL was used as a standard. The drug delivery system consisted of sterile, biocompatible, and biodegradable microparticles, with a vancomycin. To obtain bacterial killing and anti-adhesion curves, experiments were first performed in a bacterial suspension. Experiments were then perfo rmed with intraocular lenses incubated in the suspension. Efficacy was investigated by means of bacterial counting and SEM observations. Results: Both lyo p h i l i zed(LPV) and encap s u l ated(EPV) va ncomycin reduces bacterial count. Bactericidal effect of the LPV was faster: after 1 hour of incubation, bacterial reduction was about 17%, progressing to a more than 5 log reduction after 11 hours. Similar effects were observed for the EPV with a slight delay though. As to IOLs, both LPV and EPV showed significant antiadhesion properties. After 1 hour of incubation, a reduction of the counts of adhering bacteria was observed with both fo rm s . However, LPV was more efficient at earlier counts. The independent anti-adhesion effect of vancomycin was observed for both forms. At 1, 3 and 6 hours, anti-adhesion reduction was higher than bactericidal effect. From 11 hours on, the anti-adhesion and bactericidal effects could not be discriminated from each other. After 16 hours of incubation, no bacteria were found on IOL surfaces and in broth suspension. Indeed, the bactericidal effect of vancomycin became highly relevant by then. SEM observation were concordant with bacterial counting, with an increase over time in bacteria
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Abstract Book adhered to control IOLs, and a decrease over the first 6 hours, then absence of adherence to IOLs in both test groups. In all cases, bacteria adhering to IOLs were fewer than on control IOLs. Financial fundings: (None.) Conflict of interest: (None.) Keywords: microparticles, vancomycin, endophthalmitis, efficacy, bacterial adhesion, Staphylococcus epidermidis, intraocular lens, drug delivery
RF1-20 INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION IN THE TREATMENT OF VOGT-KOYANAGI-HARADA SYNDROME Belfort Jr Rubens, Andrade E Rafael, Farah E Michel, Muccioli Cristina (Instituto da Visão, I P E P O, Department of Ophthalmology, Federal University of São Paulo, Brazil) Introduction and Objectives: High-dose systemic corticosteroid therapy has become the mainstay treatment for Vogt-KoyanagiHarada (VKH) disease, but secondary side effects are frequent. We report the use of intravitreal injection of triamcinolone acetonide in the acute phase of VKH disease. Methods: Nine eyes from five patients at the acute phase of VKH disease with serous retinal detachments were treated with 4 mg intravitreal injection of triamcinolone acetonide. The following parameters were evaluated: visual acuity, intraocular pressure, as well as the height of the serous retinal detachment using optical coherence tomography (OCT). The protocol has been approved by the local Institutional Review Board, and the patients signed a written consent form before being submitted to the treatment. Results: OCT images showed a marked decrease in the retinal detachment in the first week after the injection with subsequent return to normal retinal thickness in all eyes. Follow-up ranged from 5 to 12 months with a mean of 7,8 months. No complications were observed. Conclusions: Intravitreal triamcinolone acetonide provides shortterm improvement in visual acuity and serous retinal detachments associated with VKH disease. These findings should be followed by future studies to evaluate long term effects. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Vogt-Koyanagi-Harada, Triamcinolone, Optical coherence tomography
RF1-21 VOGT-KOYA NAG I - H A R A DA DISEASE WITH CHOROIDAL NEOVASCULARIZATION IN CHILDREN Shneck Marina (Department of Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel), Levy Jaime (Department of Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel), Neumann Ron Introduction: Pediatric Vogt-Koyanagi-Harada (VKH) disease is very rare. The prognosis in this population appears to be quite variable. Up to 15 % of adult VKH cases can develop choroidal neovascularization (CNV), generally during convalescent stage, and it is usually associated with a poor visual prognosis. Objective: To report four children with VKH disease who developed CNV membranes several months after presentation.
Methods: Four children, with ages ranging between 4 and 15 years, presented with anterior and/or posterior uveitis, choroiditis, and reduced vision for a few weeks duration. Systemic work-up was negative. At presentation no extraocular manifestations were detected. Results: Systemic steroids were administered in all but one patient whose family refused treatment. Several months after presentation patients developed vitiligo and poliosis, and VKH disease diagnosis was confirmed. While on steroid tapering, eyes developed CNV membranes. All cases were controlled with immunosuppressive therapy. Final visual acuity ranged between 6/30 and 6/60 only. Conclusions: Although sometimes unrecognized, VKH may affect children. Early CNV membrane formation seems to be more prevalent compared to adults. In all cases these inflammatory membranes became stable once immunosuppressive therapy was initiated and monitored to appropriate level. In one case laser therapy was used for peripapillary CNV.Aggressive immunosuppressive therapy may halt/prevent the development of CNV. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Vogt-Koyanagi-Harada, choroidal neovascularization, children
RF1-22 PROGRESSIVE SEVERE CHORIORETINAL ATROPHY IN VOGT KOYANAGI HARADA DISEASE Sims Joanne L (Singapore National Eye Centre) Chee Soon Phaik (Singapore National Eye Centre) Introduction and objectives: Vogt Koyanagi Harada disease (VKH) is associated with development of sunset glow fundus, peripapillary atrophy and areas of chorioretinal atrophy in the chronic phase. The study examines the clinical characteristics of patients who develop enlargement of chorioretinal scars over time and determines risk factors for this development. Methods: The case notes of all patients with VKH seen at the Singapore National Eye Centre were reviewed for the presence of progressive severe chorioretinal atrophy. Patients were included if they had gradable digital fundal photographs on 2 occasions more than six months apart and at least one year of follow-up. Eyes with high myopia were excluded. Patients with progressive chorioretinal atrophy (defined as chorioretinal lesions within the temporal vascular arcades, with measurable enlargement over time) were compared to three times the number of randomly matched controls with VKH but non-progressive chorioretinal changes. Results: 44 patients met the inclusion criteria. Eight patients had progressive chorioretinal atrophy and 24 patients were randomly selected for the non-progre s s ive “control” group. The mean enlargement of chorioretinal lesions was 190% (range 113-293%, SD 69%) occurring over mean of 3.1 years follow-up (range 1-5 years). Univariate analysis of the risk factors showed recurrent anterior segment inflammation to be the major determinant for developing progressive atrophy, and recurrences that occurred more than 12 months after diagnosis had strongest correlation with risk (p=0.0061). Enlargement of atrophic lesions was documented during periods of apparent clinical quiescence in 7 of 8 patients. Exudative retinal detachment at diagnosis, degree of inflammation, choroidal thickening and chronicity at diagnosis did not correlate with risk. Conclusions: Chorioretinal atrophy can progress in some VKH
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Abstract Book patients even in the absence of active signs of choroidal inflammation. There is increased likelihood of this developing in patients with recurrent anterior segment activity. Financial fundings: No financial funding Conflict of interest: No conflicts of interest Keywords: Vogt koyanagi Harada, chorioretinal atrophy, recurrence
RF1-23 CLINICAL FEATURES OF ACUTE RETINAL NECROSIS CAUSED BY CYTOMEGALOVIRUS Yamanaka Emiko, Ohguro Nobuyuki, Okada A Annabelle, Tano Yasuo Introduction and Objectives: Acute retinal necrosis (ARN) is a necrotizing retinitis and vasculitis which, if left untreated, progresses to retinal detachment and loss of vision within a few months. Previous studies have demonstrated that both the varicella-zoster virus (VZV) and the herpes simplex virus (HSV) can cause ARN. In addition, there are a few reports suggesting that a similar clinical picture can be caused by the cytomegalovirus (CMV). The purpose of this study is to examine the clinical features of ARN caused by CMV. Methods: The diagnosis of ARN was made based on the American U veitis Society cri t e ria. A vitreous or aqueous aspirate was obtained from affected eyes and examined by polymerase chain reaction for the presence of VZV, HSV or CMV DNA. Only patients with eyes positive for CMV were included in this report. Clinical records were retrospectively reviewed. Results: Four patients (4 eyes) were diagnosed as having ARN due to CMV. One patient had undergone chemotherapy for Hodgkin?s disease but was in remission at the time of ARN onset. The remaining 3 patients were healthy without systemic symptoms. All of the patients were greater than 60 years of age (mean 69 years, range 60-77 years). Conclusion: CMV infection of the retina usually occurs as an opportunistic infection in immunocompromised individuals such as patients on chemotherapy or with acquired immunodeficiency syndrome. Although 1 patient in this report had a history of neoplasia treated with chemotherapy, the remaining 3 patients were otherwise healthy albeit elderly. These findings support previous reports of CMV as an etiologic agent for ARN, and suggest that ARN due to CMV can occur in normal, healthy individuals in the elderly age group. Financial fundings: (None.) Conflict of interest : (None.) Keywords: cytomegalovirus, acute retinal necrosis syndrome, viral retinitis
RF2-1 PAINFUL OPHTHALMOPLEGIA AS OCULAR MANIFESTATION IN CHURG STRAUSS SYNDROME AKESBI Jad (MD), DUCOS Ghislaine (MD), CASSOUX Nathalie (MD), BODAGHI Barham (PhD), LEHOANG Phuc (PhD) Introduction and objectives: To describe an unusual case of ophthalmoplegia with exophthalmia due to ocular myositis and pannucilitis in Churg Strauss syndrome (CSS). Ocular manifestations are relatively rare in this disease but could realize a severe localization
Methods: Single interventional case report. Case Report: A 56 year-old man was referred for a painful exophthalmia with complete ophthalmoplegia, proptosis and chemosis. A CSS was diagnosed with the following criteria: newly appeared asthma, hypereosinophilia (>10%), chronic rhino sinusitis with polyps, peripheral nervous system, cardiac and gastrointestinal invo l vement He was successfully tre ated by intrave n o u s immunoglobulins (i.v.Ig) but relapsed after 3 weeks. A biopsy was made and disclosed histopathologic features compatible with the diagnostic of CSS (lymphocytes, histiocytes, and eosinophilic infiltrates with a non specific vasculitis, vascular thrombi and areas of necrotizing tissues). Specific immunophenotype markers was performed and ruled out a NK/T-cell lymphoma. Conclusions: Painful ophthalmoplegia presenting as Tolosa-Hunt syndrome can realize an acute orbital inflammatory pseudotumor related to CSS. This involvement is a therapeutic emergency, because orbital inflammatory pseudotumor in CSS does not always have a benign prognosis. Orbital imaging and especially magnetic resonance imaging is a useful tool to diagnose and graduate periocular inflammation. Financial fundings: none Conflict of interest : none Keywords: CHURG STRAUSS SYNDROME, OPHTHALMOPLEGIA, ORTBITAL INFLAMMATORY PSEUDOTUMOR
RF2-2 FOLLOW-UP AND PROGNOSIS OF MARGINAL ZONE LYMPHOMAS IN OCULAR ADNEXA Z a ch a ropoulos Ioannis (Academic Medical Center (AMC), Amsterdam, Netherlands), Saeed Peerooz (Academic Medical Center (AMC), Amsterdam, Netherlands), Faridpooya Koorosh (Academic Medical Center (AMC), Amsterdam, Netherlands) Introduction and objectives: Non Hodgkin Lymphomas are the most common primary malignancy in the ocular adnexa.Marginal Zone Lymphoma (MZL) is the most common subtype(38%-86%). Most of available studies are either small groups or have short follow up period. We evaluate our patients, treated between 1980 and 2000 in our centre. Methods: Clinical and histopathological data of 82 patients with ocular adnexal lymphoma between 1980 and 2006 were reviewed and reclassified according to WHO classification, using immunohistochemical and PCR techniques. Among this group 29 patients with MZL lymphoma analysed and when necessary invited for evaluation of the stage of disease, recurrence rate, survival, and correlation between the dosage of radiotherapy and recurrence. Results: The most common location of MZL was orbit( 51.7%) followed by conjunctiva, and eyelids. The tumor was in 7% systemic. After mean follow up period of 9.5 years, 28% of the patients presented with recurrence. Recurrences mostly located in the Orbit. 7% of patients died because of tumor related causes. Patients mostly treatment with Radiotherapy. There was no significant association between the dosage of radiotherapy and recurrence rate of the tumor. Conclusions: Long term follow-up period of MZLs in ocular adnexa pressented higher rate of recurrence and systemic involvement than that found in literature. There is no association between the dosage of radiotherapy and recurrence rate. Financial fundings: (None.)
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 86
Abstract Book Conflict of interest : (None.) Keywords: Lymphoma, Marginal Zone, Adnexa
RF2-3 OCULAR ADNEXAL LYMPHOMAS Saeed P. (Orbital Center, Academic Medical Center (AMC), A m s t e rd a m , N e t h e rla nds) Faridpooya K. (Orbital Center, Academic Medical Center (AMC), Amsterdam, Netherlands), Baldeschi L. (Orbital Center, Academic Medical Center (AMC), Amsterdam, Netherlands), Zacharopoulos I. (Orbital Center, Academic Medical Center (AMC), Amsterdam, Netherlands), Bijl H. (Department of Pathology, Academic Medical Center (AMC), A m s t e rd a m , Netherlands), Mulder M. M. (Dep a rtment of Pat h o l ogy, Academic Medical Center (AMC), A m s t e rd a m , Netherlands) Introduction and Objectives: To evaluate the clinical outcome in different types of ocular adnexal lymphomas. Methods: A re t ro s p e c t ive study of 93 cases. Clinical and histopathology data were reviewed. A recl a s s i fi c ation of histopathology material according to world health organization (WHO) preformed. An additional molecular biology analysis with Southern Bloth and PCR performed. Results: Mean age in these series was 63.45 years. A total of 45 males and 48 females encountered in the study. The only child of this group was a 6 years old boy. The most common clinical sign was proptosis. Salmon patch found in 11% of patients. Orbit (55,1%) was the most common location of the tumor, followed by conjunctiva (44,8%), eyelids (6,8%) and lacrimal gland (6,8%). Location of the tumor in the eyelids or the lacrimal gland associated with more frequent systemic involvement. Imaging of 42% of these cases presented irregular margins, and bone changes detected in 24% of the cases. Based on WHO classification 43,3% of lymphomas were Marginal Zone Lymphoma (MZL), 17,9% Diffuse Large Cell Lymphoma (DLBL), 13,4% Follicular Centre Lymphoma (FL), 6% Mantel Cell Lymphoma (MCL), 4,5% Plasmacytomas (PLC), 1 case of Tcell Lymphoma (TCL) and 1 more case of Precursor B-cell Lymphoblastic Lymphoma (PBL). DLBL was associated with highest mortality (50%), followed by FL (25%) and MZL (10%). Conclusions: The most common type of lymphoma in ocular adnexa is MZL, mostly located in the orbit. Prognostic factors in ocular adnexal lymphomas are type, systemic involvement, and the primary location of the tumor. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Lymphoma, Orbit, Ocular Adnexa
RF2-4
ing the specimen and in placing it in the right manner for further microbiological evaluation. It further desribes the interpretation of various types of results and their clinical significance. A descriptive video enhances the teaching value of this presentation not only to residents but also to busy clinicians and corneal specialists. The information and tips provided are not intended to convert ophthalmologists to microbiologists, but to create a bridge between the two for better management of corneal ulcers which may at times be non-infective also. Financial fundings: None Conflict of interest : none Keywords: Keratitis, Scraping, Fungal corneal ulcers
RF2-5 TO STUDY THE ROLE OF ANTI-TUBERCULAR THERAPY (ATT) IN IDIOPATHIC UVEITIS WITH LATENT TUBERCULOSIS Gupta Amod (Post Graduate Institute of Medical Education and Research, Chandigarh) Gupta Vishali (Post Graduate Institute of Medical Education and Research, Chandigarh), Bansal Reema (Post Graduate Institute of Medical Education and Research, Chandigarh), Bambery Pra d e ep (Post Gra d u ate Institute of Medical Education and Research, Chandigarh) Introduction: Significance of a positive Mantoux test in idiopathic uveitis in an endemic,BCG vaccinated population (All known causes of uveitis have been ruled out) is not known.The present study aimed to determine the efficacy of anti-tubercular therapy (ATT) in this subset of patients. Methods: Retrospective analysis of 360 patients of idiopathic uveitis with latent tuberculosis (positive Mantoux skin test, > 10 mm of induration/necrosis) and completed a minimum follow-up of one year. All patients received standard therapy with topical and systemic corticosteroids or immu n o s u p p ressants wh e n ever indicat e d. In add ition, group A patients also re c e ived a standard 4-drug ATT for 12-18 months.Number of re c u rrences in the two groups we re compared using chi square after a minimum follow up of one year. Results: There were 216 patients in group A (104 males,112 females; mean age 34.68 Âą 12.18 years, age range 12-70 years) and 144 in group B (74 males, 70 females; mean age 34.79 Âą 10.74 years; age range 12-60 years). The median follow-up was 24 months in group A and 31 months in group B. The recurrence rate reduced significantly (p < 0.001) in group A (15.74%) compared to group B (46.53%). The patients with anterior uveitis, intermediate uveitis and posterior uveitis had a recurrence rate of 21.74%, 9.38% and 15.91% respectively in group A and 53.97%, 64.52% and 45% respectively in group B. Conclusion: Addition of 4-drug ATT to the standard corticosteroid therapy in idiopathic uveitis and latent tuberculosis led to a significant reduction in the recurrences in long term follow up. Financial fundings: None Conflict of interest : None Keywords: Latent tuberculosis, Uveitis,Anti tuberculosis therapy
CORNEAL SCRAPING VIDEO Bhartiya Prashant (Bombay Hospital, Indore) This presentation aims at encorporating the corneal scraping technique and the interpretaion of its microbiological results as part of the basic office evaluation for cases of Corneal ulcers. The basic diagnostic technique of corneal scraping and its interpretation is illustrated. It emphasises the minor technical points in tak-
RF2-7 MYCOBACTERIUM TUBERCULOSIS: A QUITE COMMON CAUSATIVE AGENT OF INFECTIOUS ORIGIN UVEITIS AND RETINAL VASCULITIS KALOGEROPOULOS CHRIS D (UNIVERSITY EYE CLINIC OF
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 87
Abstract Book IOA N N I NA , GREECE) DASKALOPOULOS GEORGE (PUL MONARY DEPARTMENT, MEDICAL SCHOOL, UNIVERSITY OF IOANNINA, GREECE) FLINDRI VASILIKI (UNIVERSITY EYE CLINIC OF IOANNINA, GREECE) Introduction and objectives: Tuberculous uveitis and retinal vasculitis induced by Mycobacterium tuberculosis are caused by a frank infection or hypersensitivity mechanisms. The aim of the study was the analysis of clinical types and the evaluation of the diagnostic and therapeutic approach of tuberculous origin intraocular inflammation. Methods: During the 20 last years we prospectively studied cases with uveitis and retinal vasculitis. Patients with positive purified protein derivative skin testing were taken into consideration for further investigation concerning tuberculosis. Patients suspected of having inflammation of tuberculous origin underwent a complete systemic evaluation and laboratory work-up; it is well known that intraocular inflammation due to Mycobacterium tuberculosis may mimic many ocular inflammatory conditions. Antituberculosis therapy alone was administered in cases with positive history or active disease. In “presumed” cases administration of steroids along with prophylactic chemotherapy was performed. Results: In 102 patients a diagnosis of “presumed” tuberculous uveitis or vasculitis was carried out. In 10 patients a concomitant pulmonary disease or positive history of tuberculosis were documented. Concerning the type of ocular involvement 77 cases experienced uveitis, 21 retinal vasculitis and 14 uveitis along with vasculitis. The uvea involvement included anterior uveitis, intermediate uveitis, choroiditis, chorioretinitis, panuveitis; vasculitis concerned almost exclusively involvement of the retinal veins. Ocular involvement was either unilateral or bilateral. Uveitis and vasculitis were resolved with good visual outcome in 80% of the cases especially after cataract surgery when performed. In 20% of the cases major complications such as uveitic glaucoma or persistent cystoid macular ? dema were present. Conclusions: Tuberculous origin uveitis and/or retinal vasculitis due to either frank infection or hypersensitivity mechanisms are not rare. However, diagnosis was difficult in those cases in which a hypersensitivity reaction was the underlying pathogenetic mechanism. Since uveitis / vasculitis due to M. tuberculosis is a treatable disease prompt diagnosis and appropriate therapy may prevent devastating ocular complications. Financial fundings: No financial funding for this study. Conflict of interest : No conflict of interest. Keywords: Mycobacterium tuberculosis, uveitis, retinal vasculitis
RF2-8 PRESENTATION AND COURSE OF SEVERE FORM OF MULTIFOCAL CHOROIDITIS Meunier Isabelle (Rothschild Foundation. Pa ri s ) , Edelson Catherine (Rothschild Fo u n d ation. Paris), Favard Cat h e ri n e ( R o t h s child Foundation. Pa ri s ) , Caputo Georges (Rothschild Foundation. Paris) Introduction: To characterise a clinical pattern of multifocal choroiditis correlated with a severe outcome and occurrence of choroidal neovascularisation. Methods: The charts of 36 patients with active multifocal choroiditis were reviewed. Results: Three of these patients present an acute form of multifocal choroiditis with a rapid and streaking progression to macular
choroidal neovascularisation. No chorioretinal lesions were noted on previous clinical and angiographic examinations in these three eyes. Initial exam reveals only new multiple active chorioretinal lesions including within an unusual large macular serous detachment. Despite high dose of corticosteroids (pulses) choroidal neovascularisation and fibrosis occur within one month resulting in a poor visual outcome. Conclusions: Multifocal choroiditis with only new and numerous active lesions within an unusual large serous retinal detachment may carry a higher risk for short term choroidal neovascularisation and severe fibrosis. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Multifocal choroiditis, acute lesion, choroidal neovascularisation
RF2-9 PERIPAPILLARY CHOROIDAL NEOVASCULARISATION IN UVEITIS: A CASE SERIES. Konstantopoulou Kallirroi (Moorfields Eye Hospital), Niskopoulou Maria (Moorfields Eye Hospital), Koufakis Dimitrios ( M o o r fields Eye Hospital), Pavesio Carlos (Moorfields Eye Hospital) Purpose: to describe the course and outcome of 8 patients with uveitis and peripapillary choroidal neovascularisation (CNV). Methods: A retrospective review of interventions and outcomes in 12 eyes of 8 patients with uveitis, who developed peripapillary CNV. The casenotes, colour photographs and fundus fluorescein angiograms were reviewed. All patients were initially treated with oral steroids and those unresponsive received PhotoDynamic Therapy (PDT), Argon laser ablation, intravitreal Bevacizumab or surgical excision of the membrane. Results: Seven of the eight patients were female. Five patients had panuveitis -one sarcoid related and four idiopathic-, one had multifocal choroiditis, one idiopathic posterior uveitis and one intermediate uveitis. Mean follow up was 5.8 years. Mean age was 48.6 years. Nine membranes were located temporally, three were encircling the disc. Eight eyes had previous optic nerve pathology. Six eyes had active inflammation when the membranes presented. Five eyes suffered recurrences, three of them multiple. Six eyes necessitated further treatment due to extension to the macula: three received Argon laser, one PDT, one surgical removal and one intravitreal bevacizumab. Mean visual acuity prior to choroidal neovascularisation was 6/12, deteriorating subsequently to 6/36. Six eyes had significant visual loss but three had coexisting macular pathology or cataract. Conclusions: Previous optic nerve pathology relating to the uveitis seems to be associated with the development of peripapillary choroidal neovascularisation. Achieving inflammatory quiescence does not seem to protect the eye from membrane activity. No significant difference in outcome existed between treatment modalities. Atrophic macular changes due to subretinal fluid or membrane extention towards the fovea eventually develop which explain the poor visual outcome despite treatment. Financial fundings: none Conflict of interest : none Keywords: Peripapillary CNV, Uveitis
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Abstract Book RF2-10 SYMPATHETIC OPHTHALMIA IN NORTH INDIAN POPULATION. Gupta Vishali (Post Graudate Institute of Medical Education and Research, Chandigarh), Gupta Amod (Post Graudate Institute of Medical Education and Research, Chandigarh), Dogra Mangat (Post Graudate Institute of Medical Education and Research, Chandigarh), Bambery Pra d e ep (Post Gra u d ate Institute of Medical Education and Research, Chandigarh) Introduction and Objectives: To report variations in presentation of sympathetic ophthalmia in our population. Methods: Between june 1989 and Dec 2004, we examined 40 patients of sympathetic ophthalmia. All had detailed ocular examination and 32 had Fundus fl u o rescein angiography (FFA). Indocyanine green angiography (ICG) was done in 6 eyes; ultrasound B scan for choroidal thickening in 19 eyes and optical coherence tomography (OCT) in 10 eyes. Histopathology of the exciting eye was done for 10 eyes. Results: There were 28 men and 12 women with a median age of 29.4 years. Thirty two patients seen in the acute phase had predominant posterior segment involvement having Harada-like picture with exudative retinal detachment (29 eyes), disc edema (14 eyes) and Dalen Fuchs nodules in 10 eyes. Only 12 of these had mildmoderate anterior segment inflammation. Only four patients had severe granulomatous inflammation at presentation. The remaining four patients were seen in the chronic phase with sunset glow fundus. Fundus fluorescein angiography done in 32 eyes showed initial hypofluorescent dots with late hyperfluorescence and dye pooling in 26 eyes; initial pin-point hyperfluorescent dots with progressive hyperfluorescence in 3 eyes and disc hyperfluoresnce in 10 eyes. USG was done in 19 eyes; 12 showed diffuse choroidal thickening. ICG in 6 eyes showed hypofluorescent lesions in three and diffuse hyperfluorescence in three eyes. OCT in 10 eyes showed multifocal serous detachments and choroidal neovascular membrane in one eye. On treatment with systemic corticosteroids and immunosupprsents, a final visual acuity of 20/40 or better could be achieved in 29 eyes over a median follow-up of 5.2 years. Eyes with anterior granulomatous uveitis at presentation had the worse prognosis. Histopathology confirmed the diagnosis in 10 eyes. Conclusions: Sympathetic ophthalmia predominantly had posterior segment manifestations in our population and carried a good prognosis. Financial fundings: None Conflict of interest : None Keywords: Sympathetic Ophthalmia, Retinal detachment
RF2-11 CLASSIFICATION OF INFLAMMATO RY MACULAR EDEMA BY USING OPTICAL COHERENCE TOMOGRAPHY Iannetti Ludovico (Dipartimento di Scienze Oftalmologiche, Università degli Studi di Roma "La Sapienza", Rome, Italy), A c c o rinti Massimo (Dipartimento di Scienze Oftalmologi ch e, Università degli Studi di Roma "La Sapienza", Rome, Italy), Live rani Marco (Dipartimento di Scienze Oftalmologi ch e, Università degli Studi di Roma "La Sapienza", Rome, Italy), C aggiano Claudio (Dipartimento di Scienze Oftalmologich e, Università degli Studi di Roma "La Sapienza", Rome, Italy), Colao Lorena (Dipartimento di Scienze Oftalmologiche, Università degli Studi di Roma "La Sapienza", Rome, Italy), Pivetti-Pezzi Paola
(Dipartimento di Scienze Oftalmologiche, Università degli Studi di Roma "La Sapienza", Rome, Italy) Introduction and objectives: To perform morphological evaluation and clinical classification of macular edema in patients with uveitis by using optical coherence tomography (OCT). Methods: 44 patients (48 eyes), 24 males and 20 females, average age 43 ± 17 years (range:6-79 years), with uveitis and concurrent macular edema were examined. All patients underwent an OCT 3. Data resulting from the OCT was examined and correlated with the anatomic location of uveitis and visual acuity (VA). Results: Three different patterns of macular edema were observed: cystoid macular edema (CME), diffuse macular edema (DME), serous retinal detachment (SRD). Twenty-nine eyes displayed CME (60.42%) and 19 DME (39.58%). SRD was found in 6 out of 29 eyes with CME (20.6%), and in 8 out of 19 with DME (27.5%). Isolated SRD was not found. Among the different types of uveitis classified by anatomical location no significant difference in macular thickness and in frequency of patterns of edema has been found. The mean VA in patients with CME was 0.43 and 0.68 in patients with DME: this difference was statistically significant (p=0.02) The mean foveal thickness in patients with CME was 455 ± 111 microns, while in those with DME was 285 ± 59 microns with a statistically significant difference (p<0.001). A univariate analysis of correlation showed a significant negative correlation between foveal thickness and VA (R = -0.66; p<0.05) as well as between foveal volume and VA (R = -0.67; p<0.05). Conclusions: OCT permits a classification of macular edema according to different morphological patterns into CME and DME. A concomitant serous retinal detachment may be found in both. CME, increase of macular thickness and of foveal volume statistically correlate to VA reduction. Financial fundings: None Conflict of interest : None Key wo rds: Optical Coherence Tomography, macular edema, uveitis
RF2-12 CORRELATION OF MORPHOLOGY AND VISUAL FUNCTION IN HUMAN OCULAR TOXOPLASMOSIS Garweg Justus G. (Swiss Eye Institute, Bern, Switzerland) Scherrer N. Janine, (Kantonsspital St. Gallen, Switzerland), Iliev E. Milko (Eye Clinic, University of Bern, Switzerland), Kodjikian Laurent (Dept. Ophthalmology, Hopital de la Croix Rousse, Lyon, France), Halberstadt Markus (Eye Clinic, University of Hanover, Germany) Background: Visual acuity and visual field testing have not systematically been assessed regarding their capability to detect a functional impact of ocular toxoplasmosis. In an own series of patients with ocular toxoplasmosis, we therefore wished to compare these functional tests with clinical and photographic documentation of ocular findings. Patients and Methods: In this prospective, cross-sectional study, 61 patients were included. From all patients, a complete ophthalmological examination was taken including visual acuity, visual field testing (Octopus perimeter, program G2), slit lamp examination and dilated examination of the fundus of both eyes. To the inclusion criteria belonged: inactive stage of the disease, and reliability factor in the VF 25%. We classified VA as normal (?20/25), mildly (20/25 to 20/60), moderately (20/60 to 20/400, low vision), and severely impaired (<20/400, legal blindness). VF damage was
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Abstract Book correspondingly graded as mild (mean defect (MD) <4dB), moderate (MD 4–12dB), or severe (MD>12dB). Results: 8 patients (13%) presented with bilat e ral OT, thus a total of 69 eyes we re incl u d e d. VF damage was encountered in 65 eyes (94%), while only 28 eyes (41%) had a reduced VA, revealing perim e t ric findings to be more sensitive (p<0.001). Correspondence with the morp h o l ogy of ch o ri o retinal scars was better for the VF (in 70% of the instances) than for VA (33%). Moderate to seve re functional impairment was regi s t e red in 65.2% for the VF, and 27.5% for VA. Conclusion: In its quiescent stage, OT had a functional impact on the 30° VF in more than 94% of study eyes. Hence, it may be used for the detection of intercurrent, functionally represented, subclinical reactivation. Standard automated perimetry represents a sensitive means of surveilling OT, and is superior to VA as a functional test in the clinical assessment of prophylactic and therapeutic strategies. Financial fundings: None Conflict of interest : None Keywords: ocular toxoplasmosis, visual function, visual acuity, visual field
RF2-13 AKREOS A DAPT VERSUS ACRYSOF INTRAOCULAR LENSES IN UVEITIC CATARACT SURGERY: A COMPARATIVE STUDY Burton Ben J (Moorfields Eye Hospital), Islam Niaz (Moorfields Eye Hospital), Pavesio Carlos (Moorfields Eye Hospital) Objectives: To establish if there is a significant difference in outcomes (visual acuity, post-operative inflammation, posterior capsule opacification, intraocular lens (IOL) deposits and macular oedema) between a hydrophobic (Acrysof) IOL and a hydrophilic (Akreos adapt) IOL, in uveitis patients undergoing standard phacoemulsification surgery. Methods: A prospective, randomised, single blinded study. Uveitis patients undergoing routine phacoemulsification, received pre-op prophylaxis according to a standardized protocol, and were randomised to receive either Acrysof or Akreos adapt. Study patients were reviewed (pre op) on the day of surgery, one we e k , and one, three, six and twe l ve months after surge ry. Refraction was performed at one month and one year after surgery. Main outcome measures: operative and post-operative complications, degree of postopera tive inflammation, best-corrected and final logmar visual acuity and central macular retinal thickness. Secondary outcome measures: IOL surface deposits, anterior rhexis measurements and posterior capsular opacification (PCO). Results: Twenty five patients were followed for 12 months. Sixteen required topical steroid treatment and nine required additional systemic pre and post-op steroid treatment. Forty eight per cent of eyes (12/25) achieved visual acuity ›70 ETDRS letters (6/12 or better), and 72% (18/25) of eyes obtained a post-operative improvement of ?15 ETDRS letters. CMO developed in 10 eyes (Akreos (n=5) and Acrysof (n=5)). Mild PCO occurred in (n=5) 20% of eyes and Nd-YAG capsulotomy was required in 8% at 12 months - Akreos topical steroids (n=1) and Acrysof systemic steroid (n=1) groups. There were no significant differences in secondary outcome measures. Conclusion: This pilot study showed no major difference in postoperative inflammatory rates or CMO in both topical and systemic regimen arms for both IOLs. Akreos Adapt lens is an acceptable alternative when compared to Acrysof lens, which is currentl y our standard IOL for uveitis
patients undergoing phacoemulsification cataract surgery. Financial fundings: Bausch and Lomb,UK. Alcon, UK. Conflict of interest : None Keywords: Uveitic cataract, Acrysof, Akreos adapt
RF2-14 CLINICAL PATTERNS OF UVEITIS IN TWO REFERRAL CENTERS IN COLOMBIA de-la-Torre Alejandra (Centro de Investigaciones Biomedicas, U n iversidad del Quindio) Gomez-Marin E Jorge (Centro de Investigaciones Biomedicas, Universidad del Quindio), L?pezCastillo A Christian (Centro de Inve s t i gaciones Biomedicas, Universidad del Quindio), Rueda C Juan (CIB, Medellin), Mantilla D Ruben (CAYRE, Bogota), Anaya M Juan (CIB, Medellin) Purpose: To describe the distribution pattern and the clinical features of uveitis in two ophthalmological referral centers from Bogota-Colombia. Methods: Retrospective analysis of clinical charts between 1996 and 2006. Results: 747 patients were found with some type of uveitis, 379 male (50.7%) and 368 female (49.3%), with a mean age in the first episode of 31.7 years (SD: 17.9). Unilateral Uveitis (n: 563, 75.4%), acute (n: 526, 70.4%), posterior (n: 253, 33.9%), and nongra nulomatous (n: 682, 91.3%) were the most common. Toxoplasmosis was the most frequent cause of uveitis (n: 276, 36.9%) followed by idiopathic cause (n: 240, 32.1%). 21% of the toxoplasmosis cases and 11.4% of the toxocariasis cases were bilaterally affected. Conclusions: Uveitis by toxoplasmosis was the most frequent entity in our study followed by idiopathic, trauma and toxocariasis. Thus, parasitic infections play an important role as cause of uveitis in Colombia. Financial fundings: Fundonal, CIB (Medellin, Colombia) Conflict of interest : Not declared Keywords: Uveitis, Colombia, Epidemiology
RF2-15 EPIDEMIOLOGY AND VISUAL OUTCOMES IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS NG Anita S. Y (Queen Mary Hospital, Hong Kong) CHAN W.N Clement (Queen Mary Hospital) LEE C.L (Queen Mary Hospital) Introduction and objective: To study the prevalence and visual clinical features of children suffering from juvenile idiopathic arthritis(JIA) – associated uveitis. Design: prospective case series Method: Queen Mary Hospital is the tertiary center for treating JIA and all affected children Hong Kong are referred for assessment and treatment. From Oct 2005 onwards, all patients with active disease are referred to the Department of Ophthalmology for screening and follow up. Their disease types, serology markers and ocular fe atures including visual acuity, intraocular pre s s u re, schirmers’ test and activity in the anterior and posterior segments were recorded. Results: There are a total of 70 patients with active JIA. The prevalence of uveitis is about 10%. Most of the affected patients are ANA positive and have pauciarticular disease. However, no female
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Abstract Book preponderance could be identified. All patients with uveitis are treated with topical steroid and no serious complication is noted in our study. Visual acuity is good in most of our patients. Conclusion: The risk of uveitis is higher in ANA-positive pauciariticular type of JIA patients. Early referral and screening could be helpful in reducing severity of uveitis in this type of patients
CASES. N g u yen Anh Minh (Croix-Rousse Hospital Lyon), Kodjikian Laurent (Croix-Rousse Hospital Lyon), Seve Pascal (Hotel Dieu Lyon), Fleury Jacques (Croix-Rousse Hospital Lyon), Broussolle Christiane (Hotel Dieu Lyon), Grange Jean-Daniel (Croix-Rousse Hospital)
Financial fundings: nil Conflict of interest : nil Keywords: juvenile idiopathic arthritis, uveitis, epidemiology
Introduction and objectives: Recently, the uveitis’ clinical classifi c ation has been re d e fined by the Standardization Uve i t i s Nomenclature (SUN) working group in 2005, which distinguishes 4 main anatomic types: anterior uveitis, intermediate, posterior and panuveitis. 3 main etiologic entities can also be differentiated: infectious disease, systemic and immune-mediated disease and ophthalmological entities. Our study aims at a descriptive analysis of the different anatomical, clinical or etiological aspects of this ocular disease. Methods: It’s a prospective analysis of the uveitis’ cases from all anatomic entities, from 2002 to 2006, in our ophthalmologic department. A part of them have been examinated by an internist physician. Patients involved by the Human Immunodeficience Virus and exo and endogenous endophthalmies have been excluded. Results: The study enroled 125 patients. Anterior uveitis and panuveitis were the most represented. The most frequent etiologies were toxoplasmosis (13.6%), sarcoidosis (12.8%), spondylarthropathy (12,8%) and Herpes Virus infections (8.8%). Concerning ophthalmologic entities, 1 Vogt Koyanagi Harada disease, 2 Fuchs heterochromic uveitis, 1 serpiginous choroidopathy and 1 Birdshot choroidopathy have been found. 37 cases (32.8%) have been considered as idiopathic and 4 cases had investigation in progress. Conclusions: Uveitis represent a large group of inflammatory involvement of the eye, in which we can distinguish many anatomic form and many etiologies. A diagnosis guidance by the ophthalmologist is possible with an anatomic and clinical approach, but a multidisciplinary consideration seems to be more and more usefull.
RF2-16 USE OF BAYESIAN NETWORKS IN DIAGNOSING SECONDARY FORMS OF UVEITIS Ardila Benjamin (Universidad de los Andes), Castillo Mario (Universidad de los Andes), Novoa J Luis (Universidad de los Andes), Garcia A Carlos (Fundaci?n Santa Fe de Bogota), Quijano Claudia (Clinica Palermo (Bogota)) Introduction and Objectives: although uveitis is often not difficult to diagnose, sometimes its secondary form is very hard to determine. Lots of those etiologic causes require a long and expensive process of careful analysis by an expert ophthalmologist, or interdisciplinary medical group, of the patient?s test results and clinical history to be diagnosed. We intended to create a Medical Decision Support System (MDSS) based on decision analysis models, in this specific case Bayesian Networks (BN), to improve and facilitate the diagnosis of the secondary form of uveitis based on a database of population with uveitis. Methods: we identified the variables that could be included in the model and built the network?s structure establishing the causal relationships between variables. We then verified the conditional independence of the variables and the absence of loops . Afterwards we defined the possible states of each variable and built a preliminary BN. We first included many of the possible variables that could be significant determining the secondary form and then created a reduced model that only included the most relevant, amongst the availabl e, va riables in a 1758 patient database of the Interdisciplinary Uveitis Center-Heidelberg. We only included four variables: gender, age, anatomic location and laterality of uveitis. Results: we developed a software application based on the Java programming language using Hugin Lite libraries that provides useful probabilistic information about previous diagnoses that can be easily used by ophthalmologists. Conclusions: It is possible to create a specific MDSS to help diagnose the secondary form of uveitis based on population data using a model based on BNs. The MDSS facilitates the determination of the secondary form of uveitis. It can be easily implemented if there is an adequate database. Results vary depending on the populations, variables included and the methods used to diagnose patients with uveitis. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Uveitis, Diagnose, BayesianNetworks
RF2-17 PROSPECTIVE STUDY OVER 5 YEARS ABOUT ALL THE UVEITIS SENT TO A TERTIARY CENTER OF OPHTHALMOLOGY: DESCRIPTIVE ANALYSIS OF THE FIRST 125
Financial fundings: none Conflict of interest : none Keywords: uveitis, epidemiology, prospective
RF2-18 ETIOLOGY AND COMPLICATIONS OF GRANULOMATOUS UVEITIS Kirikkaya Esin Tunca(Ege Unive rsity School of Medicine Ophthalmology Department), Ates Halil (Ege University School of Medicine Ophthalmology Department) Introduction and objectives: To evaluate the etiology of granulomatous uveitis and the progressing complications within time. Methods: Clinical records of patients in Ege University School of Medicine, Ophthalmology Department, Uvea Unit were reviewed retrospectively and 111 eyes of 90 patients diagnosed as granulomatous uveitis were included in this study. Results: Anterior uveitis was the most common form of granulomatous uveitis with 73%, followed by panuveitis (17.1%) and interm e d i ate uveitis (9.9%). Idiopathic gra nu l o m atous uveitis (64.9%) was the most common cause of granulomatous uveitis, followed by herpetic uveitis (13.5%), after an upper respiratory tract or a soft tissue infection (4.5%), tuberculosis (4.5%), toxoplasmosis (3.6%), sarcoidosis (3.6%), multipl scl e rosis (1.8%), pseudophacic endophthalmitis (1.8%), after a trauma (0.9%) and juvenile romatoid arthritis (0.9%). Within time seconder to uveitis,
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Abstract Book 39.6% of 111 eyes presented with cataract, followed by glaucoma (18%), cystoid macular oedema (14.4%), macular hole (4.5%) and retinal detachment (0.9%). Conclusions: Spectrum of etiology in granulomatous uveitis is wide. When a granulomatous uveitic patient is met, the very first causes should be remembered and the therapy should be managed depending on these causes and also, because of the progressing complications within time, patients must be followed more closely. Financial fundings: no Conflict of interest : no Keywords: uveitis, granulomatous uveitis, uveitic complications
RF2-19 PATTERN OF INTERMEDIATE UVEITIS IN A REFERRAL CENTRE IN TUNISIA, NORTH AFRICA Messaoud Riadh (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia), Trigui Manal (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Ben Yahia Salim (Fat t o u m a Bourguiba University Hospital, Monastir, Tunisia), Ghrissi Rim (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Attia Sonia (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia), Khairallah Moncef (Fattouma Bourguiba Unive rs i t y Hospital, Monastir, Tunisia) Introduction and objectives: To analyze the pattern of intermediate uveitis in a referral centre in Tunisia, North Africa. Methods: A retrospective, descriptive study of 87 consecutive patients (145 eyes) examined at the Department of Ophthalmology of Monastir (Tunisia) from January 1994 to August 2006. All patients underwent an extensive ocular and systemic history, a complete ophthalmic examination, and fluorescein angiography. Standard diagnostic criteria of intermediate uveitis were employed. The mean follow-up period was 43.2 months (range, 4 – 65 months). Results: The Mean age at diagnosis of intermediate uveitis was 29.1years (range, 5 – 54 years). The male-to-female ratio was 0.64. Both eyes were affected in 58 patients (66.7%). The best-corrected visual acuity at onset of uveitis ranged from light perception to 20/20 (mean, 0.6). The most frequent clinical manifestations were vitritis (100%), snowballs (53.8%), retinal vasculitis (28.3%), and snowbanks (20%). Anterior uveitis was noted in 56 eyes (38.6%). It was granulomatous in 10 eyes (6.9%). Intermediate uveitis was most commonly idiopathic (86.2%). Sarcoidosis (9.2%) and multiple sclerosis (2.3%) were the most common systemic diseases associated with this type of uveitis. The most common complications were cystoid macular edema (39.3%), cataract (31.7%), optic disc edema (26.2%), and glaucoma or ocular hypertension (9%). One hundred and twelve affected eyes (77.2%) had a final visual acuity more than 20/40. Conclusion: In a hospital population in Tunisia, intermediate uveitis started frequently at the end of the third decade and had a female predominance. This type of uveitis was most commonly idiopathic. Cystoid macular edema and cataract were the most frequent complications. Visual prognosis appeared to be fairly good, particularly with strict control of inflammation and proper management of complications. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Intermediate uveitis, epidemiology, Tunisia
RF2-20 RECURRENCE CHARACTERISTICS IN HUMAN OCULAR TOXOPLASMOSIS Garweg Justus G.(Swiss Eye Institute, Bern, Switzerland), Scherrer Janine (Kantonsspital St. Gallen, Switzerland) Background: Ocular toxoplasmosis (OT) is associated with a substantial number of patient visits each year, thus reinforcing an interest for a better understanding of the disease. Patients and Methods: Of 139 patients with OT retrospectively contacted with the approval of the Local Institutional Ethical Committee, 63 completed a questionnaire. The data were reconfirmed with those from clinical records. Parameters of interest included patient-reported age at first manifestation and in our records documented age at first presentation and of recurrences. Patients were then categorized according to median age at first OT manifestation. For all comparisons, the level of significance was set at p=0.05. Results: The mean reported age at first OT was 23.9 (median 20.9, 0–70.5, +/-12.9) years. The clinical diagnosis was made 3.5 years later (p = 0.0008). The mean follow up time had been 6.5 (median 5.0; 0.6–49.9, +/-7.6) years. The two groups (group 1: <20.9 years; n=35; group 2: ?20.9 years; n = 28) differed in their recurrence rates with 66% for the former and 39% for the latter (p<0.05). Patients reporting only one episode (n=16) had a mean age of 26.9 (median 25.6; 10.6–70.5; +/-14.3) years, those reporting two episodes (n=19) were younger at first presentation [mean age 17.9 (median 19.5; 5.9–33.9; +/-7.8) years; p<0.05]. The portion of patients developing a recurrence after their last episode remained with 50-70% stable, as did the time to recurrence with 1.0-1.7years. Conclusion: Younger patients are at a higher risk for recurrences of their OT. After each OT episode two thirds of patients will develop a next episode after a surprisingly short time to recurrence. Financial fundings: None Conflict of interest : None Keywords: Ocular Toxoplasmosis, Recurrence, Age
RF2-21 POSTSURGICAL CYSTOID MACULAR EDEMA IN PATIENTS IN TREATMENT WITH PROSTAGLANDINS. OUR EXPERIENCE. PAZ MORENO-ARRONES JAVIER (UNIVERSITY HOSPITAL PRINCIPE DE ASTURIAS), CASTEJON CERVERO A MIGUEL (UNIVERSITY HOSPITAL PRINCIPE DE ASTURIAS), BOLIVAR DE MIGUEL GEMA (UNIVERSITY HOSPITAL PRINCIPE DE ASTURIAS), GUTIERREZ ORTIZ CONSUELO (UNIVERSITY HOSPITAL PRINCIPE DE ASTURIAS), DRAKE RODRIGUEZCASANOVA PILAR (UNIVERSITY HOSPITAL PRINCIPE DE ASTURIAS), TEUS GUEZALA A MIGUEL (UNIVERSITY HOSPI TAL PRINCIPE DE ASTURIAS) Introduction and objetives: To review the incidence of clinically symtomatic postsurgical cystoid macular edema (CME) in patients with glaucoma or ocular hy p e rtension in tre atment with prostaglandins (PG) who had undergone cataract surgery or combined cataract and glaucoma surgery. Methods: We have re a l i zed a prospective study of one hundred eye s t h at we re underwent cat a ract surge ry or combined glaucoma and cat a ract surge ry and who we re under hypotensor treatment with prostaglandins befo resurge ry. The appearing of cl i n i c a l lysymtomatic cystoid macular edema in the postoperative period was eva l u at e d.
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Abstract Book Results: CME was only present in two patients of the one hundred eyes reviewed. Both patients suffered from diabetes non-insulindependent. One of the patients presented the CME in both eyes. In both patients surgery was undergone without complications. Conclusions: The incidence of postsurgical CME in patients who undergo cataract or combined surgery and previously treated with prostaglandins is low. Financial fundings: NO Conflict of interest : The incidence of postsurgical CME in patients who undergo cataract or combined surgery and previously treated with prostaglandins is low. Keywords: Cystoid macular edema, prostaglandins, surgery
RF2-22 CAT SCRATCH DISEASE ASSOCIATED WITH BRANCH RETINAL ARTERY OCCLUSION Shulman Shiri (Sorasky Tel-Aviv Medical Center, Tel-Aviv,Israel), Shulman Shiri (Sorasky Tel-Aviv Medical Center, Tel-Aviv, Israel), Goldstein Michaela (Sorasky Tel-Aviv Medical Center, Tek-Aviv, Israel), Weissbord Michael (Sorasky Tel-Aviv Medical Center, TelAviv, Israel), Lowenstein Anat (Sorasky Tel-Aviv Medical Center, Tek-Aviv, Israel) Introduction: Cat scratch disease (CSD) is usually a benign self limiting disease caused by Bartonella henselae bacterium. The clinical course of the disease usually begins with a cat scratch which is often overlooked and followed by r egional lymphadenopathy. Ocular manifestations of Bartonelosis are uncommon and variable. They include Parinaud oculoglandular syndrome, neuroretinitis and focal retinochoroiditis. We reviewed the literature and present three rare cases of branch retinal artery occlusion (BRAO) associated with CSD. Methods: Retrospective case series Results: All charts of patients diagnosed with CSD that attended the retina clinic in the Tel-Aviv Medical center between January 2001-March 2007 were reviewed. 3 patients with branch artery occlusion were included (one male and two females), mean age 33 (27-50). All presented with visual symptoms. Visual acuity in the affected eye ranged from 6/7.5 to 6/120, Clinical examination and fluorescein angiography demonstrated branch retinal artery occlusion. One patient had bilateral artery occlusion. One had an OCT scan demonstrating the ischemic area adjacent to the occlusion. All patients had cats and all had positive serologic tests for Bartonella henselae. All patients were treated with Doxicycline and Rifampine with complete resolution of the ischemic area within 6-8 weeks. Visual acuity improved in all patients. Conclusions: BRAO may be the first manifestation of CSD. Visual acuity is affected according to the location of the obstructed artery but usually improves with treatment. Financial fundings: non Conflict of interest : non Keywords: Cat Scratch disease, Retinal Artery Occlusion,Ischemia
RF2-23 UNUSUAL PRESENTATION OF INTRAOCULAR CYSTICERCOSIS ABBAS ZAHIR (ALL INDIA INSTITUTE OF MEDICAL SCI ENCES (AIIMS), VENKATESH PRADEEP (AIIMS), MANDAL SUBRATA (AIIMS), GARG SATPAUL (AIIMS) Introduction and objectives: To report an unusual case where two
larvae were found in the vitreous cavity, one dead and one live along with a subretinal cyst of Taenia solium. We show the video demonstrating removal of the intact live larva. Methods: An eighteen year old girl presented with symptoms of pain, redness and decrease of vision in the left eye. Clinical features, diagnosis, surgical procedure and outcome were evaluated. Results: She had a vision of 6/6 OD and perception of light only OS. Both anterior chamber and vitreous cavity showed signs of inflammation. On fundus examination 2 larvae were seen in the pre-retinal location, one dead and the other live. A translucent cyst with the invaginated scolex was also seen in sub-retinal space. Three port pars plana vitrectomy was done and larvae were aspirated intact with the vitrectomy probe alongwith removal of cyst and sent for parasitological examination. In the immediate post-operative period there was central retinitis with retinal edema and vision was perception of light. Microbiological examination revealed cysticercus scolex. Conclusions: Rarely live larvae may be encountered simultaneously with cysticercus cyst in eye and cause severe inflammation. An aspirated intact larva is helpful for parasitological examination. Financial fundings: NONE Conflict of interest : NONE Keywords: LIVE CYSTICERCOSIS LARVAE
RF2-24 CONFOCAL MICROSCOPY IDENTIFIES REVERSIBLE SUB-CLINICAL STROMAL INFLAMMATION IN UVEITIS PATIENTS Sheppard John D (Eastern Virginia Medical School and Virginia Eye Consultants), Lattanzio A Frank (Eastern Virginia Medical School and the Thomas R. Lee Center for Ocular Pharmacology), Williams B Patricia (Eastern Virginia Medical School and the Thomas R Lee Center for Ocular Pharmacology), Tant G Rezalina (Virginia Eye Consultants), Scoper V Stephen (Eastern Virginia Medical School and the Thomas R Lee Center for Ocular Pharmacology) Introduction: Uveitis patients are traditionally evaluated by slit lamp biomicroscopy (SLB) to assess the presence and degree of intra-ocular inflammation. Many patients achieve remission, manifest by the absence of detectable cell or flare, with or without topical steroids. Confocal microscopy (CM) offers a more sensitive method to detect indolent sub-clinical inflammation, thereby guiding therapeutic intervention. Methods: 14 patients with uveitis were treated with sufficient topical corticosteroids to induce a cell and flare free remission. Diagnoses included sarcoidosis (S-5), HLA-B27 disease (B27-3), rheumatoid arthritis (RA-2), trauma (T-2) and herpetic uveitis (HSV-2). Once stabilized for a period of 3 months, confocal microscopy was performed. Results: Corneal stromal leukocytic infiltrates and aqueous protein were detected in 11 of the patients, including S (4), B27 (3), RA (1), T (1) and HSV (2). Thereafter these patients received topical steroids at 3 fold baseline frequency for a period of at least one month. Confocal findings of inflammation decreased in all 11 patients, and dissipated completely in 6: B27 (2), RA (1), T (1), and HSV (2). Patients suffered no untoward effects from the serial confocal measurements. Conclusion: Patients with clinically quiet eyes on topical steroid maintenance for uveitis in a variety of conditions can demonstrate reve rsible sub-clinical corneal and aqueous inflammation
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Abstract Book detectable by confocal microscopy. These findings define a more sensitive measure of remission, and suggest caution prior to surgical intervention or further weaning of anti-inflammatory medications in patients who appear to be in remission by SLB. Financial fundings: Thomas R. Lee Center for Ocular Pharmacology, Virginia Eye Foundation Conflict of interest : Dr. Sheppard receives grant support and/or consultant and/or lecture fees from Alcon, Allergan Inc., Bausch & Lomb Inc., Isis Pharmaceuticals, Lumenis, Ophthalmic Mutual Insurance Company, Santen Inc., Inspire, and Vistakon Pharmaceuticals LLC. Keywords: confocal microscopy, inflammation, uveitis
RF2-25 UVEITIS AND CYSTOID MACULAR EDEMA: Perinti Andrea , Menicacci Felice Cystoid macular edema (CME) often accompanies uveits. In this case we have studied by HRA Angiography a case of polypoidal choroidopathy diagnosed following an episode of acute uveitis complicated with CME Differential diagnosis is discussed with the help of "ex iuvantibus" crtieria In conclusion uveitis with CME is not always uveitic CME Financial fundings: NHS Conflict of interest: None Keywords: uveitis CME CNV
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Abstract Book PO1-01-01
PO1-01-03
ROLE OF PHOTODYNAMIC THERAPY FOR THE TREATMENT OF PEDIATRIC CORNEAL AND RETINAL OCULAR DISORDERS M. Fortunato, R. Maggi, A. Ubaldi, P. Vadala Photodynamic Therapy Unit (M. Fortunato) Department of Ophthalmology (P. Vadala) Bambino Gesu Children’s Hospital, Rome
ADALIMUMAB AND JUVENILE IDIOPATHIC ARTHRITIS ASSOCIATED UVEITIS CLEMENT ANA (HOSPITAL UNIVERSITARIO NINO JESUS, MADRID) VALLS ISABEL (HOSPITAL UNIVERSITARIO NINO JESUS, MADRID) ANDRES MARIA LUISA (HOSPITAL UNIVER SITARIO NINO JESUS, MADRID) JIMENEZ CLARA (HOSPITAL UNIVERSITARIO NINO JESUS, MADRID)
In the last 4 years 62 PDT treatments were performed at the PDT unit of Bambino Gesu children’s hospital in hereditary affections (Best’s dystrophy), angiomatoses (Von Hippel-Lindau), autoimmune disorders (Leber-Coats’ disease), ametropia (degenerative myopia), trauma, corneal neovascularization, etc. Materials and methods: We performed PDT in children both under anesthesia and at the slit-lamp with a 90 D Volk lens similarly as in adults, without encountering problems of drug-related toxicity or significant collateral effects (photoactive dermatitis, pain) but only minor complications following the intravenous administration of verteporphine, such as nausea and vomiting. The treatment of disorders for which no alternative treatment was available was successful, permitting us either to arrest the evolution of the condition, or to improve vision, thus improving the otherwise negative prognosis of many pediatric ocular diseases, such as Best?s maculopathy. Conclusions: The use of PDT in pediatric ophthalmology has entailed a great improvement in the treatment of many serious disorders with limited therapeutic options. The low toxicity, together with care in the prevention of complications, permits the use of the procedure in children as in adults.
INTRODUCTION AND OBJECTIVES: To report 4 cases of juvenile idiopathic arthritis (JIA)-associated uveitis treated with adalimumab. METHODS: We retrospectively evaluated 4 patients with JIAassociated uveitis who were treated with adalimumab at a dose of 40mg/m2/every 2 weeks for 4 months. 3 girls with a pauciarticularonset JIA and a male HLA B27 positive with an enthesitis- related arthritis. Mean age at treatment onset was 12 years old. In these patients, previous antiinflammatory therapy with systemic steroids, methotrexate and etanercept had been ineffective. 2 of them, while on etanercept had shown a worsening of their uveitis when methotrexate was tapered. RESULTS: Adalimumab was effective in all of the patients, 3 of them showing no relapses of uveitis at all. One child required an increase of medication with good response. Neither was observed any relapses of arthritis. No additional immunosuppressive treatment was required. No adverse events were reported. CONCLUSIONS: Adalimumab may be an effective therapy for children with JIA- associated uveitis refractory to treatment with systemic steroids, methotrexate and other inhibitors of tumor necrosis factor alpha as etanercept.
Financial fundings: (None.) Conflict of interest : (None.) Keywords VERTEPORPHINE, PEDIATRIC, NEOVASCULARIZATION
Financial fundings: none Conflict of interest : none Keywords: ADALIMUMAB, JUVENILE IDIOPATHIC ARTHRITIS, UVEITIS
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ISOLATED ANTERIOR CHAMBER RELAPSE IN A CHILD WITH CHRONIC MYELOID LEUKEMIA Kim Myoung Joon (Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center)
PERIPHERAL RETINOSCHISIS AND RETINAL DETACHMENT IN PEDIATRIC INTERMEDIATE UVEITIS Denisova Ekaterina Valerievna (Helmholtz Research Institute of Eye Diseases Moscow, Russia), Katargina Anatolyevn Ludmila (Helmholtz Research Institute of Eye Diseases Moscow, Russia), Meshkova Ivanovna Galina (Helmholtz Research Institute of Eye Diseases Moscow, Russia), Starikova Viktorovna A l ex a n d ra (Helmholtz Research Institute of Eye Diseases Moscow, Russia)
A 7-year-old boy presented with unilateral anterior uveitis. Eleven months before, he had undergone a bone marrow transplantation to treat Philadelphia chromosome-positive chronic myeloid leukemia (CML). He remained in complete remission with imatinib (Gleevec) maintenance therapy. Aqueous humor cytology revealed leukemic blasts. Donor leukocyte infusion and radiotherapy were added for the treatment of ocular relapse. After the treatment, anterior chamber (AC) infiltrations disappeared completely. Isolated AC infiltration is a rare relapsing form of CML, which has not been reported in children under imatinib treatment. Uveitis can be the sole presentation of leukemic relapse, and prompt AC aspiration should be performed for the diagnosis. Financial fundings: (None.) Conflict of interest : (None.) Keywords: leukemia, anterior chamber, imatinib
Objective: To evaluate frequency, clinical features and efficiency of treatment peripheral retinoschisis and retinal detachment (RD) in pediatric intermediate uveitis (IU). Methods. Complex clinical study 130 children aged 2 – 17 years with IU (224 affected eyes) up to 10 years follow-up. Results: Retinal complications were detected in 32 (14%) eyes. Peripheral retinoschisis was revealed in 11 (5%) eyes after 1 – 7 years of onset of IU. It located inferiorly, extended for 1 – 4 hours, was mostly bullous and resulted from peripheral membranes contraction. Boundary laser photocoagulation performed in 8 cases. No schisis progression was detected during 5 years follow-up. Retinal folds or detachment occurred in 21 (9%) eyes as a consequence of traction bands formation and shrinkage during first attack of uveitis (15 cases) or after 2 – 5 years (6). They were mostly (15) local with optic nerve involvement in ? of cases. Subtotal RD was revealed in 6 eyes with retinal tears in 4 of them. Boundary
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Abstract Book laser photocoagulation performed in 2 cases (peripheral retinal fold, local RD) resulted in their stabilization. YAGlaser membranes dissection in 1 eye led to diminish the RD. After vitrectomy (8), scleral buckling (5) or combined surgery (2) attachment was achieved in all cases with small retinal folds in 7 eyes. After surgery visual acuity improved in 87% cases and finally ranged from 0.01 to 0.7. Main causes of poor vision were macular scarring and optic atrophy. Conclusion: One of the peculiarities pediatric IU is high incidence of vitreous and epiretinal membranes formation and high complications rate (14%) associated with vitreoretinal traction. Laser photocoagulation helps to restrict the schisis progression. Early vitrectomy may prevent complications and save good vision. Financial fundings: (None.) Conflict of interest : (None.) Keywords: pediatric intermediate uveitis, peripheral retinoschisis, retinal detachment
PO1-01-06 UVEITIS ASSOCIATED WITH REITER`S SYNDROME IN CHILDREN Drozdova Elena A. (Ural State Medical Academy Posdiploma Education), Tarasova N. Larisa (Ural State Medical Academy Posdiploma Education) Reiter`s syndrome (RS) is autoimmune disease characterized typical triad of symptoms: urethritis, arthritis and conjunctivitis. The AIM: to study clinical characteristics of children with uveitis associated with RS and the role of Chlamidia trachomatis in it`s etiology. METHODS: Nineteen patients (12 boys and 7 girls) age from 0 to 16 years were prospectively observed from 1980 to 2004 in several Chelyabinsk clinics. Their family history, age of onset RS, clinical manifestations, ocular symptoms, laboratory data, HLA-B27 were analyzed. Chlamidia trachomatis were isolated in conjunctival, urethral and cervical swabs from children and their mothers in the McCoy cell culture and by polymerize chain reaction (PCR), serotyping of Chlamidia was performed by enzyme immunoassay. RESULTS: Fourteen from 19 (73,7%) patients were born premature, four from them by operative methods. All of children had paratrachoma in neonatal period and different extraocular disease in early childhood: chronic rhinitis, otitis, bronchopneumonia, vulvovaginitis. Classic triad manifestation of RS revealed in age from 6 to 14 year. Ocular involvement in RS characterized acute anterior uveitis (78.9 %), intermediate uveitis (10.5 %), chorioiditis (10,5%), papillitis (31.6%). All of patients had chronic bilateral recurrent conjunctivitis with positive PCR test to Chlamidia trachomatis. The urogenital symptoms were: urethritis (5), prostatitis (3), vulvovaginitis (5), cystitis (3), pielonephritis (3) with positive PCR in 11 cases. All mothers tested also were positive for Chlamidia trachomatis in urogenital tract. The immunotyping of Chlamidia from mother and child revealed the same serotypes. The arthritis developed before uveitis in 8 (47,3 %) patients, simultaneo u s ly with uveitis (15.8%), after attack of uveitis (42,1%). Recurrent attacks of uveitis were in 6 (31.6%) patients. CONCLUSION: Reiter`s syndrome in children may be associated with acute anterior recurrent uveitis, combined with chronic conjunctivitis and persistent Chlamidia in urogenitall tract and conjunctiva. Financial fundings: no
Conflict of interest : no Keywords: uveitis, conjunctivitis, Reiter syndrome
PO1-01-07 INCIDENCE, RISK FACTORS AND VISUAL PROGNOSIS OF UVEITIS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS Angioi Karine (CHU de Nancy), Crance Joelle (CHU de Nancy), Lemelle Irène (CHU de Nancy), Maalouf Toufic (CHU de Nancy) Introduction: Uveitis is the most frequent extra-articular manifestation of juvenile idiopathic arthritis (JIA). We therefore aimed to describe incidence, risk factors and visual prognosis of uveitis in children with JIA. Methods: Observational single center retrospective study Results: Over a 15-year period, we examined 61 children with JIA (female gender 85%, mean age 4.9+/-4 years, polyarticular form 53%, oligoarticular 47%). Before 2000, children were referred on the basis of ophthalmologic symptoms and systematically later on. During the observational period uveitis was present in 30/61 children in the whole population (49%) and in 13/41 (31%) in those examined after 2000. Uveitis was present at the 1st examination in 63% and occurred after 1.7+/-2 years for the others. Female gender (56 vs 11%, p<0.026) and positive antinuclear antibodies (87 vs 24%, p<0.013) were associated with the occurrence of uveitis. Uveitis was posterior in 23% and bilateral in 73%. Initial visual impairment with visual acuities 3/10 and 1/10 were 10% (3/30) and 3.3% (1/30), respectively, and at follow-up 16.7% (5/30) and 6.6% (2/30), respectively. None of the children had such a bilateral vision loss. An ocular complication occurred in 11/30 children (36.7%) (cataract 6, synechies 8, macular oedema 2, macular epiretinal membrane 1, macular hole 1, ocular hypertension 3), requiring specific ocular intervention in 8 (surgery or intravitreal injection). Presence of ocular complications was related to poor visual outcome (visual impairment in the case of complication 36.4% vs 5.3% if not, p<0.047), posterior uveitis was of borderline significance (42.9% vs 8.7%, p<0.068). Conclusion: In our series uveitis is a very frequent extra articular manifestation of JIA that may lead to ocular complications and visual loss. Financial fundings: none Conflict of interest : nothing to disclose Keywords: Uveitis, juvenile idiopathic arthritis, visual prognosis
PO1-01-08 OCULAR GRANULOMA, UVEITIS AND X-LINKED C H RONIC GRANULOMATOUS DISEASE: A CASE REPORT Angioi Karine, (CHU de Nancy), Maalouf Toufic (CHU de Nancy), PĂŞcheur Charles (CHU de Nancy), Chastagner Pascal (CHU de Nancy) Case report: a two-year old boy was referred for unilateral red eye associated with fever lasting for one month despite many treatments. Slit-lamp examination revealed conjunctival redness, anterior uveitis, small iridal whitish dots and posterior synechiae. Fundus was not accessible. An endogenous endopthalmitis was suspected. Despite treatments the eye worsened with a white mass in the anterior chamber. General ex a m i n ation revealed fever, decreased weigh, hepatomegaly, splenomegaly and a fungal pneumopathy. A
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Abstract Book CGD was suspected and the X-chromosom analysis confirmed a mutation in the gp 91 phox (the b subunit of cytochrome b558). General corticotherapy was associated with antifungal and antibiotic treatments. The white mass in the eye, probably a granuloma, and inflammation disappeared rapidly but posterior synechiae remained and the eye has no light perception. Discussion: CGD is a rare inherited disorder of phagocytic cells. It results from an inability of phagocytes to produce bactericidal superoxide anions (O2-). This leads to recurrent life-threatening bacterial and fungal infections. CGD is now known to be caused by a defect in the nicotinamide adenine dinu cleotide phosphate (reduced form) (NADPH) oxidase enzyme of phagocytes. The most common molecular defect in CGD is a mutation in the CYBB (cytochrome B, b subunit) gene that is located on the X chromosome and that encodes for gp91 (the b subunit of cytochrome b558). Gp91 deficiency accounts for 50-70% of all cases of CGD. The most frequent ocular manifestations are juxta vascular chorioretinal lesions, keratitis, conjunctivitis. Current therapy for CGD is based on antimicrobial prophylaxis, early and aggressive treatment of infections. Conclusion: in our case the ocular localisation is rare and occured initially as a presenting symptom of the disease. Financial fundings: none Conflict of interest : nothing to disclose Keywords: ocular granuloma, uveitis, X-linked chronic granulomatous disease
PO1-01-09 DIAGNOSTIC AND THERAPEUTIC MANAGEMENT OF POSTERIOR AND PANUVEITIS IN CHILDREN P ra zeres Sandra (Ophthalmology Department, Hôpital PitiéSalpêtrière, Paris, France), Terrada Céline (Ophthalmology Department, Hôpital Pitié- Salpêtrière, Paris, France), Quartier Pierre (Pediat ric Immu n o l ogy-Rheumat h o l ogy Unit, Hôpital N e cker -Enfants-Malades, Pa ri s , France), P rieur Anne-Marie (Pediatric Immunology-Rheumathology Unit, Hôpital Necker Enfants-Malades, Pa ri s , France), Bodaghi Bahram (Ophthalmology Department, Hôpital Pitié- Salpêtrière, Paris, France), LeHoang Phuc (Ophthalmology Department, Hôpital Pitié- Salpêtrière, Paris, France) Purpose : To analyse the etiologic distribution, therapeutic strategies and ocular complications of both posterior and panuveitis in children. Patients and Methods: Retrospective analysis of patients aged under 18 and refered for the first time to the Pitié-Salpetrière’s Ophthalmology Department between 2002 and 2005. The diagnostic and therapeutic approaches were evaluated. Anterior and intermediary uveitis were excluded. Results: In a total population of 148 children with uveitis, 39 (26.3%) were included with a diagnosis of posterior uveitis or panuveitis. The average age was 9.6 years (min 1 and max 17 years old) and the sex ratio was 1.2 (F/M). Uveitis was bilateral in 66.7% of cases, posterior in 17 cases (43.6%) and total in 22 cases (56.4%). An etiology was found in 29 cases (74.4%). An infection was diagnosed in 35.9% of cases. Ocular toxoplasmosis was the most common cause in this group, namely half of the cases. In the non-infectious group, we found 5 cases of Behçet’s disease, 4 cases of CINCA syndrome, 3 cases of biopsy-proven sarcoidosis, 2 cases of suspected sarcoidosis and 1 case of Vogt-Koyanagi-Harada syndrome. Uveitis was diagnosed as idiopathic in 25.6 % of cases. The
most frequent complications were posterior synechiae (21.1%), cataract (16.4%) and cystoid macular edema (14.8%). Systemic corticosteroids were necessary in 64.1 % of cases, and immunosuppressive drugs were used in 41% of cases. Ophthalmic surgery was necessary in 26.2% of cases. Discussion: Both posterior and panuveitis are rare in children. It is mandatory to eliminate an infectious etiology before proposing an effe c t ive and systemic anti-infl a m at o ry or immu n o m o d u l at o ry treatment that may control ocular inflammation and improve visual prognosis. Conclusion: Uveitis remains a serious cause of visual morbidity. An early diagnosis and treatment may improve the visual prognosis. Financial fundings: (None.) Conflict of interest : (None.) Keywords: posterior uveitis, panuveitis, children.
PO1-01-10 CATARACT SURGERY OUTCOMES IN JUVENILE IDIOPATHIC ARTHRITIS ASSOCIATED UVEITIS Acevedo Sarah M. (Massachusetts Eye Research and Surgery Institute), Quinones Karina (Massachusetts Eye Research and Surgery Institute), Rao Veena (Massachusetts Eye Research and Surgery Institute), Cervantes-Castañeda A. Rene (Massachusetts E ye Research and Surge ry Institute), Foster C. Stephen (Massachusetts Eye Research and Surgery Institute) Purpose: To analyze visual outcomes following cataract extraction in patients with juvenile idiopathic art h ritis (JIA) associated uveitis. Methods: In this retrospective cohort study , we reviewed the clinical records of patients younger than 18 years old with JIA associated uveitis followed from January 1985 to December 2005. We identified 24 patients (30 eyes) who underwent cataract extraction with follow-up of ? 1 year. The main outcome measure was postoperative visual acuity (Va) after 1 year. Results: The mean age of patients at surgery was 8.95 ± 4.08 years (range: 4-16). The majority of patients were female (21/24) and had anterior uveitis (22/24). Posterior segment pathology was found perioperatively in 14 (46.6%) eyes. Most patients (20/24) had established immunomodulating therapy (IMT) and all were controlled for at least three months prior to the surgery. Mean visual acuity (in decimal units) was 0.045 ± 11.0 lines preoperatively and 0.225 ± 7.4 lines one year after surgery, which in Snellen equivalents amounts to approximately 20/500 and 20/90, respectively. Overall, 93.3% (28/30) of eyes showed improvement or maintenance of VA, while 6.7% (2/30) of eyes worsened. The majority of patients with poor postoperative visual acuities 20/200 had preexisting retinal or optic nerve pathology. In addition, 76.7% (23/30) eyes underwent concomitant pars plana vitrectomy, of which 21 (91.3%) showed improved vision. Twenty-three eyes (76.7%) were left aphakic, while 7 (23.3%) had intraocular lens implantation. The 7 ey es (7 patients) which received an IOL implant had improved vision 1 year following the procedure, and 4 of these eyes had best corrected visual acuity of 20/20. Conclusions: Patients with JIA associated uveitis may benefit from cataract extraction given careful patient selection, optimal control of inflammation, and meticulous surgical planning. Following these parameters, we found that intraocular lens implantation was well tolerated in our cohort of children with JIA associated uveitis. More long-term visual outcomes studies are needed before there is
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Abstract Book a consensus about IOL implantation in JIA patients with uveitic cataract. Financial fundings: None Conflict of interest : No conflicts of interest Keywords: CATARACT, PEDIATRIC, UVEITIS
PO1-01-11 BIOLOGIC AGENTS IN THE TREATMENT OF REFRACTORY PEDIATRIC UVEITIS Quinones Karina (Massachusetts Eye Research and Surgery Institute) Gallagher J Micheal (Massachusetts Eye Research and Surgery Institute) Yilmaz Taygan (Massachusetts Eye Research and Surgery Institute) Cervantes-Casta単eda A Rene (Massachusetts Eye Research and Surge ry Institute), Foster C. Stephen (Massachusetts Eye Research and Surgery Institute) Purpose: To assess the efficacy and safety of biologic agents in the treatment of noninfectious, refractory pediatric uveitis. Methods: Retrospective, non-comparative case series of all pediatric patients from our Institue with recalcitrant uveitis treated with a biologic agent. Outcome measures included the quantitative measurement of intraocular inflammation and changes in visual acuity. Results: Twenty three children (46 eyes) with refractory uveitis were identified. This included 18 females and 5 males with an average age of 11.2 years (range: 4-18). Thirteen patients were treated with infliximab, five with adalimumab, and five with daclizumab for an average of 16.9 months (range: 1.3-54.1). All patients had bilateral eye involvement. Diagnoses of the participants included Ju venile Idiopathic Arthritis associated uveitis, ke ratouveitis, Sarcoid panuveitis, Adamantiades- Behcets disease, and Idiopathic panuveitis. In the infliximab group 16 of 26 (62%) eyes demonstrated an improvement in visual acuity while 20 of 26 (77%) eyes showed decreased intraocular inflammation. In the adalimumab group, 4 of 10 (40%) eyes demonstrated an improvement in visual acuity with 5 of 10 (50%) eyes exhibiting an improvement in inflammation. Four of 10 (40%) eyes in the daclizumab cohort had improved visual outcomes with 8 of 10 (80%) eyes demonstrating an improvement in inflammation. All but 3 of the patients successfully discontinued systemic prednisone. The flare-up rate in this study group was 40%. Disease remission was achieved in 3 patients; one with infliximab and 2 with daclizumab. Therapy was generally well tolerated in all groups. Transient alteration in liver function tests and leukopenia were observed in 3 patients receiving infliximab and one using daclizumab. None of these resulted in discontinuation of their treatment regimens. Conclusions: Biologic agents appear to be well-tolerated in children, representing a valuable therapeutic adjunctive drug group in a host of recalcitrant childhood uveitides. Financial fundings: None Conflict of interest : No potential conflicts Keywords: pediatric uveitis, case series, biologic agents
PO1-01-12 ATYPICAL CHORIORETINITIS IN CONGENITAL TOXOPLASMOSIS (CASE PRESENTATIONS) Bagdoniene Rasa (Vilnius university hospital), Sirtautiene Rasa (Vilnius University hospital) Introduction and objectives: Toxoplasmic chorioretinitis is the most common manifestation of congenital toxoplasma infection. Ocular toxoplasmosis causes irreversible damage to the retina in utero. We would like to present fundus appearance of congenital toxoplasmosis in premature and full term infants. Methods: One premature infant (gestation age (GA) 28 weeks at birth) examined at 32 weeks of GA on routine screening for retinopathy of prematurity and one full term infant examined at the age of two weeks. Indirect fundus ophthalmoscopy was performed for both infants. Serologic tests were used to diagnose T. gondii infection. Results: Atypical indistinct chorioretinal lesions were observed in central part of the fundus on both eyes of premature infant. Atypical multiple foci of retinal necrosis scattered on the whole fundus of both eyes were observed in full term infant. Serologic tests revealed congenital toxoplasmosis in both infants. All other tests for congenital infections were negative. Conclusions: It is necessary to perform ophthalmoscopy for all new born infants in an attempt to identify and treat T. gondii infected infants. Protection of women particulary pregnant ones from Toxoplasma infection is a must. Financial fundings: no support Conflict of interest : no Keywords: Toxoplasmic chorioretinitis, premature infant, multifocal chorioretinitis
PO1-02-01 UNUSUAL CASE OF LARGE LIVE CYST IN ANTERIOR CHAMBER Kai Sanjay (All India Institute of Medical Sciences, New Delhi , India), M Vanathi (All India Institute of Medical Sciences, New Delhi , India), Vengayil Sujith (All India Institute of Medical Sciences, New Delhi , India), Sen Seema (All India Institute of Medical Sciences, New Delhi , India), Dada Tanuj (All India Institute of Medical Sciences, New Delhi , India), Panda Anita (All India Institute of Medical Sciences, New Delhi , India) Introduction and objectives: Cysticercosis is a parasitic infestation of human tissue by Taenia solium in which human beings are intermediate hosts. Ocular involvement occurs in 46% of the infested patients.Anterior chamber cysticercosis is unusual . We report a unique case of a very large live cyst in the anterior chamber which was removed intoto. Methods: A 16-year old female presented with 4 months history of white reflex and dimunition of vision in her left eye.The best corrected visual acuity was 1/60 on snellens chart.Slit lamp biomicroscopic examination revealed a live grayish white cyst in the anterior chamber. The ultrasonographic evaluation of the orbit and adnexa was normal. The ultrabiomicroscopic (UBM) evaluation revealed a large live cyst with movements of scolex well visualised.Computed Tomography(CT) scan revealed multiple noncontrast enhanced lesions with calcification in brain.The cyst was removed intoto surgically using the double incision and viscoexpression technique.
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Abstract Book Results: On gross examination, the cyst was grayish white with dimension 0.8cm x 0.5cm and histopathological analysis confirmed the diagnosis of cysticercus cellulosae.The patient regained best corrected visual acuity of 6/6 on snellens chart. Conclusion: To the best of our knowledge this is the largest ever reported live cyst in the anterior chamber(AC).Inspite of its size there was very minimal inflammation in AC.The intoto removal of the cyst with minimal damage to the surrounding structures is always advised to prevent post operative inflammation. The large size of the cyst precluded the intoto removal by the already described viscoexpression technique in literature.Our described technique ensured intoto removal with no added inflammation in the post operative period. Financial fundings: nil Conflict of interest : nil Keywords: cysticercosis, live cyst, Ultrasonic biomicroscopy
PO1-02-02 ANTERIOR SEGMENT MANIFESTATIONS OF HIV INFECTIONS IN INDIA IN THE ERA OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY Gharai Sujit (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,), Garg Satpal (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,), Ve n k atesh Pra d e ep (Dr. Rajendra Prasad Centre fo r Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,), Vohra Rajpal (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,) Introduction & Objectives: Evaluation of anterior segment manifestations in patients with HIV infection in the era of HAART at tertiary eye care centre in India. Methods: A detailed ophthalmological and systemic examination was performed on each patient between September 2004 and September 2006. Results:135 consecutive HIV infected patients were examined for ocular manifestations. Of these 20% had category A HIV infection, 23.7% had category B HIV infection, 56.3% had category C HIV infection (AIDS indicator condition). 74% were male and 26% were female. The median age of patients was 34 yr. 62.2% patients were on HAART. 11.1% patients had anterior segment manifestations.1/3rd patients had bilateral invo l vement. Complicated cataracts (6.7%) were most common anterior segment manifestations. Complicated cataracts were secondary to retinal detachment, immune recovery uveitis, acute retinal necrosis, active CMV retinitis, cryptococcal choroiditis, and vitreous hemorrhage. Other manifestations included keratitis (3%) and keratouveits (0.7%).One patient presented to us with peripheral ulcerative keratitis as presenting sign of HIV infection. Conclusions: There seems to be an increased risk of developing anterior segment complications, with the introduction of providing low cost or free HAART in India, due to increase in life expectancy and immune recovery. Financial fundings: none Conflict of interest : nil Keywords: Anterior segment, HIV , AIDS,
PO1-02-03 L O N G I T U D I NAL STUDY OF ANTERIOR SEGMENT INFLAMMATION BY ULTRASOUND BIOMICROSCOPY IN PATIENTS WITH ACUTE ANTERIOR UVEITIS Oianli Meng (Zhongshan Ophthalmic center, State Key Laboratory of Ophthalmology, Sun Yat-sen Unive rs i t y ) , Peizeng Yang (Zhongshan Ophthalmic center, S t ate Key Laboratory of Ophthalmology, Sun Yat-sen Unive rs i t y ) , Hongyan Zhou (Zhongshan Ophthalmic center, S t ate Key Laboratory of Ophthalmology, Sun Yat-sen University), Li Wang (Zhongshan Ophthalmic center, State Key Laboratory of Ophthalmology, Sun Yat-sen University), Xiangkun Huang (Zhongshan Ophthalmic cen ter, State Key Lab o ratory of Ophthalmology, Sun Yat-sen University), Aize Kijlstra ( the Animal Production Division, Animal Sciences Group and Research Center, Wageningen University and the Department of Ophthalmology, University of Maastricht) Introduction and objectives: To investigate the dynamic changes in the anterior segment of patients with acute anterior uveitis (AAU) using ultrasound biomicroscopy (UBM). Methods: AAU was diagnosed in 18 patients according to history and ocular examinations. UBM was performed and the results at three time points, namely within 2 weeks, between 2 and 4 weeks and 6 weeks after the uveitis attack, were analyzed. The relationship between clinical manifestations and UBM findings were also evaluated. Results: All investigated patients with AAU showed severe ciliary injection, numerous dust Keratic Precipitates (KP), aqueous flare and cells, and were treated predominantly with corticosteroid and cycloplegic eye drops. UBM showed a large number of cells in the anterior and posterior chamber, marked edema and exudates in and around the iris-ciliary body within 2 weeks after AAU onset. These abnormalities improved dramatically at 2 and 4 weeks and almost disappeared at 6 weeks and thereafter. Conclusion: UBM reveals severe inflammatory changes in and around the ciliary body in patients with AAU. These signs rapidly resolve upon treatment. Financial fundings: Supported by the Fund for Project of Science and Technology of Guangdong Province (2004B50301002), the Natural Science Foundation for Research Groups of Guangdong Province (05200176) and ?5010? Clinical Project of Sun Yat-sen University. Conflict of interest : None of the authors has a proprietary or financial interest in any product mentioned. Key wo rd s : u l t rasound micro s c o py, acute anterior uveitis, the dynamic changes
PO1-02-04 OCT IN ACUTE ANTERIOR UVETIS. A PROSPECTIVE FOLLOW-UP STUDY PAZ MORENO-ARRONES JAVIER (UNIVERSITY HOSPITAL PRINCIPE DE ASTURIAS) TEUS GUEZALA A MIGUEL (UNI VERSITY HOSPITAL PRINCIPE DE ASTURIAS) GORRONO ECHEVARRIA B MARINA (UNIVERSITY HOSPITAL PRINCIPE DE ASTURIAS) Introduction and objectives: To investigate by optical coherence tomography (OCT) the macular thickening, the state of the optic disc and retinal nerve fibers layer (RNFL) in patients with an episode of acute anterior uvetis (AAU), and compare the results with the evaluation of the same parameters 1 month later.
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Abstract Book Methods: In this prospective, follow-up study, 27 consecutive eyes of 20 patients with an episode of AAU were recruited. The age ranged between 8 and 78 years old, and all were evaluated by the scans ‘fast macular thickness’, ‘fast optic disc’ and ‘fast RNFL thickness’ by OCT within the first 3 days of their AAU and then, 1 month later, on both occasions under mydriasis. Results: No statistically significant differences were found at 1 month in the macular volume in AAU eyes. At three days, total macular volume in uveitic eyes was 7,36 +/- 0,5 mm? and one month later it was 7,31 +/- 0,7 mm? (mean +/- standard deviation) (p=0,4). Indeed, no statistically significant differences were found in the thickness of the inferior and superior RNFL when the first and second explorations were compared. Imax/Smax at three days was 0,97 +/- 0,1 and at 1 month 0,98 +/- 0,1 (p=0,71), and Smax/Imax at three days was 1,05 +/- 1,1 and at 1 month 1,04 +/1,1 (p=0,67). Only 6 eyes had active inflammation and 8 eyes had treatment with corticosteroids 1 month after the beginning of the episode. Conclusions: OCT analysis has revealed that changes observed in the posterior pole of patients suffering an AAU episode persist one month later, even though the inflammation in the anterior segment has resolved and the visual acuity improved. Financial fundings: NO Conflict of interest : OCT analysis has revealed that changes observed in the posterior pole of patients suffering an AAU episode persist one month later, even though the inflammation in the anterior segment has resolved and the visual acuity improved. Keywords: OCT, UVEITIS, INFLAMMATION
PO1-02-05 IMMUNOSUPPRESSION IN HLA-B27 ASSOCIATED ANTERIOR UVEITIS Ko s t a kou A go ri (University of Aberdeen), Amer Radgonde (Unive rsity of A b e rd e e n ) , Fo rrester V John (Unive rsity of Aberdeen) Introduction and Objectives: Indications of immunosuppression in patients with HLA-B27 associated anterior uveitis. Methods: Retrospective study of 13 consecutive patients with HLA-B27 associated anterior uveitis from the Ophthalmology Department of Aberdeen Royal Infirmary (1999 to 2006). Results: Ten patients were males (90%) and 3 were (10%) females. Mean age of onset was 30.3 yrs (range 20- 47). Patients fell into 2 groups according to how they were treated. Five patients (38.5 %) received a short course (1 month) of oral steroids. The indications for Prednisolone were: persistent inflammation (3 patients), vitritis (1 patient) and cystoid macular oedema (CMO) (1 patient). Eight patients (61.5 %) received a long-term (over 1 year) combination of Prednisolone with addition of a second-line immunosuppressant (Cyclosporine,Tacrolimus or Mycophenolate Mofetil) for the following indications: high recurrence rate (2 patients), peripheral retinal vasculitis (2 patients), CMO and papillitis (2 patients), papillitis with no macular involvement (1 patient ) and vitritis (1 patient). Mean visual acuity in patients who received a short course of oral steroids remained unchanged before and after treatment and was eventually 6/7.5 (range 6/9-6/6). Their relapse rate was 1.2 per year. Patients managed with long-term treatment had a visual acuity of
6/9 (range 6/60-6/6) before IMS and 6/7.5 (range 6/18-6/6) at their last visit (on remission). Their relapse rate decreased from 2.8 to 1.9 attacks per year. Conclusion: HLA-B27 associated-anterior uveitis in most cases responds rapidly to topical steroids. In some cases there is a more serious threat to vision and systemic immunosuppression may be required. The results of this study show that the main indication for short-term management was persistent inflammation and for longterm control was posterior segment involvement and high recurrence rate. Financial fundings: None Conflict of interest : None Keywords: Anterior uveitis, HLA-B27, Immunosuppression
PO1-02-06 DISTURBANCE OF IMMUNE RESPONSE REGULATION IN PATIENTS WITH HLA-B27 ASSOCIATED UVEITIS Drozdova Elena A. (Ural State Medical Academy Posdiploma Education), Teplova N. Svetlana (Ural State Medical Academy Posdiploma Education), Tarasova N. Larisa (Ural State Medical Academy Posdiploma Education) Purpose: To determine the role of activation and apoptosis of lymphocytes in the immunopathogenesis of uveitis associated with HLA-B27. Methods: Immu n o l ogical ex a m i n ation was perfo rmed in 76 patients (48 men and 28 women, mean age 36.8 ± 14.0 y) in acute stage of intraocular imflammation. The systemic deseases were determined in 52 patients. The study was included: CD typing lymphocytes of peripheral blood, morphological estimating of apoptosis of lymfocytes, determination of the level of Bcl-2 expression by cytometric analysis and level of TNF-·, INF-Á and Il-4 in serum by enzyme immunoassay. Results: We found: decrease in 1.5 times contents of CD3, CD4, CD8 and some increase ratio of CD4/CD8. In the other hands we determined raise of CD16, CD22 and increase quantity of lymphocytes having early and late activation markers – CD25, CD71, HLA-DR. The examination of the apoptosis revealed significant decrease of quantity of lymphocytes expressed Fas- receptor and lymphocytes with morphological sings of apoptosis. Analysis of serum was revealed 5 times grater concentration of proinflammatory and proapoptotic cytokine INF-Á, TNF-· and 1.6 times of IL-4 that correlated with severity of uveitis (r=0.476; p=0.001). The quantity of Bcl-2 expression cells was higher than in control in 2 times. There were no immunologic differense between patients either with or without associated systemic disease. Conclusion: The study suggest that abnormality of the balance of cells typical for processes of negative and positive activation of lymphocytes and its apoptosis that may be associated with hight level of antiapoptotic agents like Bcl-2 despite hight levels of proapoptotic cytokines. Financial fundings: no Conflict of interest : no Keywords: uveitis, HLA-B27, ophthalmoimmunology
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Abstract Book PO1-02-07 KERATOUVEITIS SECONDARY TO OPHTHALMOMYIASIS Zaouali Sonia (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia), Ammari Wafa (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Bouladi Mejda (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Turki Khalil (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Ben Yahia Salim (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia), Khairallah Moncef (Fattouma Bourguiba Unive rs i t y Hospital, Monastir, Tunisia) Introduction and objectives: To report a case of ophthalmomyiasis presenting as keratouveitis. Methods: Case report Results: A 70-year-old man, with unremarkable medical history, presented with a 4-day history of visual loss and redness in his right eye. Visual acuity was 20/400 in the right eye. Slit-lamp examination revealed diffuse conjuctival hy p e remia, c o rneal stromal edema, linear tracks in the corneal stroma, granulomatous keratic precipitates, and 1 + cells in the anterior chamber. Intraocular pressure was 12 mm Hg. A single larva moving on the conjunctival surface was detected. No evident intraocular larva was found. The examination of the left eye was unremarkable. The larva was removed and identified as oestrus ovis. Two days later, there was a dramatic improvement of ocular symptoms and signs. Conclusions: Ophthalmomyiasis should be considered in the differential diagnosis of keratouveitis especially in particular geographic areas. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Stromal keratitis, Uveitis, Ophthalmomyiasis
PO1-02-08 QUANTATIVE ASSESSEMENT OF THE EFFECTS OF PUPILLARY DILATION ON AQUEOUS FLARE IN EYES WITH CHRONIC ANTERIOR UVEITIS USING LASERFLARE PHOTOMETRY I keji Felicia C (Moorfields Eye Hospital), White T Edwa rd (Moorfields Eye Hospital), Pavesio E Carlos (Moorfields Eye Hospital) Introduction and objectives: To establish what, if any, effect dilation has on the aqueous flare of chronic uveitic patients when measured with a flare meter. Methods: One affected eye was selected from a group of 25 patients with A n t e rio r Uveitis. Exclusion cri t e ria included any significant corneal opacities/abrasions and posterior synechiae. Anterior chamber inflammation was assessed by one experienced operator, using the Kowa Laser Flare Meter (FM-500) to the nondilated study eye. Ten measurements were taken in total, with the highest and lowest measurements deducted. The mean value and standard deviation were recorded. One drop of Tropicamide 1% and Phenylephrine 2.5% was applied to the study eye. After a total of 30 minutes, the measurements were repeated and the results recorded. Results: 16 women (64%) and 9 men (36 %) were recruited. The majority were white Caucasian (68%). Fifteen left and 10 right eyes were studied and the median visual acuity was 6/9 (6/6-6/18).
The mean age was 50.8 years old, standard deviation 12.59 The median flare reading before dilation was 17.93 (8.33-29.93), and after dilation was 15.97 (10.17-29.4). For some patients Bland Altman plots showed flare readings decreased after dilation whilst for others readings increased. The mean change was -0.74 but the 95% limits of agreements ranged from -6.91 to 5.43. Conclusions: No cl i n i c a l ly significant diffe rence was fo u n d between flare readings take pre and post dilation. Bland Altman plots showed very good agreement between the flare measurements of dilated and undilated patients Financial fundings: Nil Conflict of interest : Nil Keywords: Uveitis, Photometry, Flare
PO1-03-01 IMPLICATIONS OF CATARCT SURGERY IN SERO NEGATIVE LEPROSY Yagnik Hetalkumar R (Rotary Eye Institute), Mehta Falguni (Rotary Eye Institute), Billore Omprakash (Rotary Eye Institute), Das Sumita (Rotary Eye Institute) INTRODUCTION AND OBJECTIVES: To study outcome of cataract surgery in sero negative leprosy patients. METHODS: We operated 38 patients out of 80 patients examined in Leprosy Home, Surat. We studied age-sex distribution, type & duration of disease, treatment taken in years. Systemic deformity manifestation, preoperative and postoperative visual acuity, pigment dispersion over IOL, PCO development and complication occurrence. Patients were followed up at the end of 1 week, 1 month, 2 month and 6 months. All patients were given steroidantibiotic drops up to 6 months in slow tapering dose and also oral steroids for 1st 15 days postoperatively. RESULTS: 83.33% cases were lepromatous type and rest of tuberculoid type. Pre operatively out of 38 patients 19.44% had hand movement VA, 67.64% < 6/60, 11% were between 6/60-6/18. Postoperatively 33.33% had > 6/18 VA, 50% had 6/60-6/24 and only 17.6% had <6/60 VA. PCO was noticed in 64.76% cases, pigment dispersion over IOL in 52.92% cases. Posterior capsular rent was encountered in 8.82% cases. In 5.88% cases accidental ICCE occurred, synechiolysis was required in 17.5% cases. CONCLUSIONS: C at a ract surge ry in sero negat ive lep ro s y patients is safe and sight saving procedure developing countries with complications rate similar to non leprosy cases, except they require frequent follow up and longer duration of steroid therapy. Financial fundings: Rotary Eye Institute,Navsari,Gujarat,India Conflict of interest : nil Keywords: sero-negative,lepromatous,steroid therapy
PO1-03-02 A NOVEL APPROACH TO EVALUATE DIFFERNT TYPES OF LENS OPACITIES WITH ANTERIOR SEGMENT OPTICAL COHERENT TOMOGRAPHY Wong Amy L (The Chinese University of Hong Kong), Leung KS Christopher (The Chinese University of Hong Kong), Cheng KC Arthur (The Chinese University of Hong Kong), Lam SC Dennis (The Chinese University of Hong Kong) Objectives: To differentiate opacities using the Visante anterior segment optical coherent tomography(ASOCT).
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Abstract Book Methods: Cross-sectional observational case series. There were seven patietns with various types of cataract were imaged with the ASOCT high resolution horizontal linear scan. The images were then calibrated and combined to evaluate the loca Results: Patients aged from 7 to 77 years old were imaged without difficulties. The ASOCT clearly identified the location and extension of different lens opacities. Anterior polar, posterior polar, posterior subcapsular, cortical and nuclear lens opacities all were characterized and differnetiated in the ASOCT images. The intensity of the reflectivity signal in the ASOCT images corresponded well to the lens density seen with slit lamp biomicroscopy. The integrity of the lens capsule was well demonstrated with the ASOCT images. Conclusion: The ASOCT could provide rapid, non invasive and high resolution assessment of various types of lens opacities and information about the lens capsular status would be useful in the surgical planning for selected cases. Financial fundings: No Conflict of interest : No Keywords: Cataract, Visante anterior segment OCT, lens opacities
PO1-03-03 ULTRASOUND BIOMICROSCOPY (UBM): ROLE IN IDENTIFICATION OF RETAINED NUCLEUS FRAGMENT AFTER PHACOEMULSIFICATION. GAVALA CAT E R I NA (IPPOCRATIO GENERAL HOSPITAL), KYRIAKOPOULOS NIKOS (IPPOCRATIO GENERAL HOSPI TAL), AGGOS IOANNIS (IPPOCRATIO GENERAL HOSPITAL), AKRITOPOULOS PANAGIOTIS (IPPOCRATIO GENERAL HOS PITAL), PATIAKAS STEFANOS (IPPOCRATIO GENERAL HOS PITAL), AKRITOPOULOU KIRIAKI (IPPOCRATIO GENERAL HOSPITAL) OBJECTIVE: To assess the usefulness of UBM in viewing posterior chamber retention of nucleus fragments after phacoemulsification, with posterior chamber intraocular lens (IOL) implantation, and no intraoperative complications. METHOD: In our clinic patients after phacoemulsification are submitted to regular control 1 day 3 and 7 days after surgery. 7 patients from January 2002 to March 2006 presented iris elevation. There were no intraoperative complication and IOL in posterior chamber was well implanted. UBM was performed during the third control. RESULT AT: the third day control visual acuity was 20/20 in 4 of 7 patients. 3 patients showed 20/30. 3 patients presented light anterior segment inflammation. None of the patients revealed anterior chamber inflammation the seventh day. At the slit lamp examination localized iris elevation was noted. UBM revealed small retained fragment of nucleus, between iris pigment epithelium and anterior lens capsule causing anterior displacement. CONCLUSION: UBM can be very useful to make certain diagnosis of retained nucleus fragment after phacoemulsification allowing location and permitting exact surgical removal. Financial fundings: (None.) Conflict of interest : (None.) Keywords: phacoemulsification, UBM, nucleus fragment
PO1-03-04 EFFICACY OF A SINGLE DOSE TRIAMCINOLONE ACETATE (TMC) INJECTION, IN PATIENT WITH UVEITIS A NA M N E S I S, DURING PHACOEMULSIFICATION, TO PREVENT FIBRIN FORMATION. GAVALA CATERINA (IPPOCRATIO GENERAL HOSPITAL), KIRIAKOPOULOS NIKOS (IPPOCRATIO GENERAL HOSPI TAL), AGGOS IOANNIS (IPPOCRATIO GENERAL HOSPITAL), AKRITOPOULOU KIRIAKI (IPPOCRATIO GENERAL HOSPI TAL), PATIAKAS STEFANOS (IPPOCRATIO GENERAL HOSPI TAL), AKRITOPOULOS PANAGIOTIS (IPPOCRATIO GENERAL HOSPITAL) OBJECTIVES: To evaluated weather a single dose of intraoperative TMC injection can be more effective than preoperative and postoperative therapy with low dose oral methylprednisolone. METHODS: Two groups of 4 and 6 patients respectively with uveitis anamnesis, between 57 and 65 years of age were studied from October 2005 to January 2007. In the first group 4mg of TMC were injected in the anterior chamber. The second group was submitted to low dose oral methylprednisolone for one week before surgery and one week after. Both groups were normally IOL implanted in posterior chamber. Follow up included controls at 1 day, 7 days and 1 and 3 months postoperatively. RESULTS: The 2 groups did not vary significantly in best visual acuity during follow up and final visual acuity, at the end of the follow up. No significant increase of intraocular pressure was noted in both groups. Fibrin formation was not seen in TMC treated group while in1 patient under oral methylprednisolone occurred. CONCLUSIONS: A TMC single dose intraoperative therapy in patients with uveitis anamnesis can be more effective in preventing fibrin formation after phacoemulsification. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Triamcinolone, uveitis, phacoemulsification
PO1-03-06 BACTERIAL KERATITIS FOLLOWING PHOTOREFRACTIVE KERATECTOMY (PRK). GAVALA CATERINA (IPPOCRATIO GENERAL HOSPITAL, KIRIAKOPOULOS NIKOS (IPPOCRATIO GENERAL HOSPI TAL), GEORGANTIS HLIAS (IPPOCRATIO GENERAL HOSPI TAL), PAPADOPOULOU ANATOLI (IPPOCRATIO GENERAL HOSPITAL), AGGOS IOANNIS (IPPOCRATIO GENERAL HOS PITAL), KOTSIDAS IOANNIS (IPPOCRATIO GENERAL HOSPI TAL) OBJECTIVE: To investigate the cause of bacterial keratitis in patients that underwent PRK. METHODS: 4 patients who were submitted for moderate to high myopia from 2000 to 2006 de veloped bacterial keratitis .All patients fitted bendage contact lens after surgery and antibiotic as well as antiflammatory treatment was prescribed .Severe ocular pain, lid edema, photophobia, purulent discharge, corneal melting due to dense corneal infiltration was noted. Smear and culture were obtained .Antibiogramme was also performed. RESULTS: Staphylococcus Epidermidis, Staphylococcus Aureus, Enterococcus and Pseudomonas Aeruginosa were isolated .In 2 patients more than 1 microbe was identified. Patients were treated with topical fortified antibiotic and background systemic therapy. Ulcers were controlled with medical therapy and amniotic mem-
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Abstract Book brane transplantation. However tectonic penetrating keratoplasty was required in 1 eye. CONCLUSION: Contact lens use can play a role in infection keratitis as well as uncontrolled bl e f h a ritis .Culture and antibiogramme can allow exact identification and target treatment avoiding ulterior complication as total uveitis, endopthalmitis. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Bacterial, keratitis, PRK
PO1-03-07 SURGICAL TREATMENT FOR GLAUCOMA AFTER PERIOCULAR TRIAMCINOLONE ACETONIDE Julián Lilian K (Hospital Universitario Austral), Couto A Cristóbal (Universidad de Buenos Aires) Introduction and Objetives: periocular triamcinolone acetonide ( either sub-Conjunctival, sub-Tenon or peribulbar) has became a common treatment for many inflammatory ocular diseases. Among its side effects, secondary glaucoma is one of the most serious and usually occurs in predisposed subjects. We report five patients with refractory glaucoma after sub-Tenon triamcinolone injection who underwent surgical removal of the steroid deposit and achieved intraocular pressure (IOP) control. Methods: prospective, consecutive, interventional case series of five eyes in five patients who underwent surgical removal of triamcinolone acetonide periocular deposit as tre atment of stero i d induced glaucoma. Results: all five patients who underwent surgical removal of triamcinolone deposit were unresponsive to maximal medical glaucoma treatment. The underlying diseases were HLA-B27 associated uveitis (2 patients); pars planitis (1 patient); Birdshot Retinochoroidopathy (1 patient) and penetrating keratoplasty rejection (1 patient). All patients had previously received topical steroid treatment without an IOP raise. The periocular injections were performed by different ophthalmologists with different techniques. The median IOP at the time of surgery was 30mmHg (r=22-38); all the surgical procedures were performed by the same surgeon (C.C.) with successful results in all cases. The median IOP after surgery was 15mmHg (r=12-18). Only one patient needed anti glaucomatous topical medication after surgery, with full control of the IOP. The median follow up was 12 months. Conclusions: secondary glaucoma is a possible side effect of periocular steroid treatment and it can’t be predicted by the IOP response to topical steroids. The injection technique is important: the more anterior and more superficial the injection the more probable the rise in IOP. If medical treatment is ineffective in controlling IOP, surgical excision of the steroid deposit should be performed as soon as possible. Financial fundings: none Conflict of interest : none Keywords: STEROID,GLAUCOMA,SURGERY
PO1-03-08 TRABECULECTOMY WITH MITOMYCIN C FOR UVEITIC GLAUCOMA Julián Lilian K (Hospital Universitario Austral), Couto A Cristóbal (Universidad de Buenos Aires) Introduction and Objetives: management of uveitic glaucoma re f ra c t o ry to medical therapy is complex and challenging. Trabeculectomy (TEC) and wound healing modulation with antifibrotic agents, such as Mitomycin C (MMC) improves the success rate in these high risk eyes but the risk of complications is also increased. Another approach is the use of tube shunts (or glaucoma drainage implants) as an alternative to trabeculectomy with its own risk profile. The aim of this study is to report the results of a cohort of uveitic patients who underwent TEC with MMC as primary surgery for uveitic glaucoma. Methods: prospective, consecutive, interventional case series of twelve eyes in twelve caucatian patients who underwent TEC with MMC as first surgery for uveitic glaucoma. Results: all twelve patients who underwent TEC with MMC presented uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy. The following uveitic diagnosis were present: Fuchs Heterochromic Iridociclytis (9 patients); Herpes Virus associated uveitis (2 patients) and Juvenil Idiopathic Arthritis (JIA) associated uveitis (1 patient). The median IOP at the time of surgery was 30mmHg (r=22-38). All TEC were performed superiorly using a limbus-based conjunctival flap with intraoperative MMC in a concentration of 0.2mg/ml. 75% of patients achieved complete success (IOP < 21mmHg without topical medication). Two patients needed a reoperation and were considered complete failure. The median follow up was 12 months. Conclusions: TEC with MMC is a safety option for the treatment of uveitic glaucoma in selected patients. It’s important to emphasize that our sample size is small and composed of white patients with a high preponderance of Fuchs Heterochromic Iridociclytis. Our results could not be generalized to all uveitis etiologies. Financial fundings: no Conflict of interest : no Keywords: trabeculectomy, antimetabolites, uveitis.
PO1-03-09 CATARACT SURGERY IN EYE WITH SYMPATHETIC OPHTHALMIA Taskapili Muhittin ( Vak›f Gureba Education Hospital Eye Clinic I s t a n bu l , Turkey ), Tugal-Tutkun Ilknur ( . Dep a rtment of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.) We present the case of a 14 years old male with symphathetic ophthalmia who underwent uneventful cataract surgery in the sympathizing eye. At presentation his best corrected visual acuity (BCVA) was 4/10 in left eye and right eye was phthisical with no light perception. There were +++ cells in the anterior chamber , ++ vitritis and seclusio pupillae in the left eye. At fundus examination, the left optic disc was swollen with blurred margins, and there were the Dalen- Fuchs scars. Systemic azathioprine, cyclosporine A and corticosteroid therapy was initiated. Six months later posterior subcapsuler cataract developed and vision was reduced in his left eye. He was under remission with therapy.Under general anesthesia we performed phacoemulsification, removal of the lens capsule, and anterior vitrectomy. At the end of the surgery we injected intravitreal
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Abstract Book triamsinolone acetonide. Postoperative course was uneventful and three months later the left eye BCVA was 8/10. The systemic therapy was continued. Conclusion: Cataract surgery can be safely performed in patients with sympathetic ophthalmia with aggressive immunosuppression and the adjunctive use of intravitreal triamcinolone acetonide. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Cataract surgery, Symphathetic ophthalmia
PO1-03-10 CATARACT SURGERY IN PATIENTS WITH VOGT-KOYANAGI-HARADA SYNDROME Couto Cristobal A (Universidad de Buenos Aires ), Schlaen A Ariel (Universidad de Buenos Aires), Tau A Alejandro (Universidad de Buenos Aires) Purpose: To describe the results of cataract surgery performed in patients with Vogt Koyanagi Harada syndrome. Methods: We studied 22 eyes of 16 patients. Preoperative and postoperative best corrected visual acuity (BCVA), surgical technique, complications and perioperative medical treatment were recorded. Results: Preoperative BCVA was less than 20/200 in 16 eyes, while postoperative BCVA was greater than 20/60 in 16 eyes. We performed phacoemulsification in all cases . Pars plana vitrectomy (PPV) and posterior capsulotomy in 16 eyes of 14 patients. Those patients with hydrophobic acrylic IOL implantation had significatively less relapses than patients with PMMA IOL implantation (Fisher exact test; p= 0.046). However, none of the IOLs needed to be explanted. Severe postoperative inflammation was recorded in 4 eyes. Conclusion: Phacoemulsification with IOL implantation associated with PPV and posterior capsulotomy, in combination with a suitable perioperative medical management, achieve a good visual outcome in patients with Vogt Koyanagi Harada syndrome. Acrylic hydrophobic IOL implantation appeared to be associated with less postoperative inflammatory relapses. Financial fundings: none Conflict of interest : none Keywords: VKH, CATARACT, IOL.
PO1-03-11 THERAPEUTIC PENETRATING KERATOPLASTY FOR NON TRAUMATIC CORNEAL PERFORATIONS LIMAIEM RYM (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA), TURKI FARES (HEDI RAIS INSTITUT OF OPHTALM OGY TUNISIA), MERDASSI AHLEM (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA), ZARROUK BESMA (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA), MGHAEITH FATMA (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA), EL MATRI LEILA (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA) Introduction: corneal perforation may occur in some ocular diseases. This condition can requires an emergency penetrating keratoplasty. The aim of our study was to retrospectively analyze predisposing conditions leading to perforation and visual outcomes after penetrating keratoplasty. Methods: a review of 19 consecutive patients (2003 to 2007) who underwent therapeutic keratoplasty for non traumatic corneal per-
foration performed at the institute of ophthalmology of T unis. Mean patient age was 51,5 years (range 31 – 81 years) and the mean follow-up was 16,5 months. Results: the diseases associated with perforation were neurotrophic ulcer in 2 cases (10,5%), dry eye in 5 cases (26,31%), bacterial corneal ulcer in 6 cases (31,57%) and herpetic corneal ulcer in 6 cases (31,57%). All patients had specific adapted medical treatment before surgery. The graft remained clear in nine eyes (47,3%). Postoperative complications were graft ectasia (one eye), ocular inflammation (4 eyes), superficial ponctuate keratitis (4 eyes), corneal ulcer (4 eyes), posterior synechiae (2 eyes) and ocular hypertension (1 eye). Conclusion: corneal ulceration leading to perforation can occur after infection, corneal dryness and exposure keratitis. When corneal ulceration does not respond to medical treatment, a penetrating keratoplasty allows the elimination of infected tissue and antigenic material. In spite of the great number of complications the percentage of success is about 50%. Financial fundings: (None.) Conflict of interest : (None.) Keywords: therapeutic keratoplasty, perforation, keratitis
PO1-03-12 APPLICATION OF FLOGENZIM IN TREATMENT OF CONGENITAL CATARACT Aubakirova Aigul (Kazakh Eye Research Institute), Keikina Lyazzat (Kazakh Eye Research Institute), Puchko Snezhanna (Kazakh Eye Research Institute) Purpose: Evaluate the efficacy of general enzymotherapy in children operated of congenital cataract. Methods. 17 children aged 4 to 14 years underwent surgical treatment of congenital cataract. Macular oedema was observed in 64%, maculopathy in 36% of cases. These children of main gr oup received Flogenzim in postoperative period with anti-inflammatory purpose. Control group consisted of 16 children with macular oedema in 66,7% and maculopathy in 33,3% of cases. Macular zone was evaluated by OCT on 4th day after operation and after 1 month. Results: Visual acuity in main group increased by 0,28±0,02, in control group by 0,23±0,02. According to OCT there were 3 states of macular zone: macular oedema, macula hypoplasia and maculopathy. In early postoperative period macular oedema (221,2±36,6 nm) was observed in half of main group (54%) and of control group (50%). Macular hypoplasia (189±2,9 nm) in 10% and 22% correspondingly. In 36% of cases of main group and in 33% of control group organic changes of neuroepithelium. After one month visual acuity increased by 0,15±0,09 in main group and by 0,08±0,02 in control group. According to OCT in main group in all cases regression of macular oedema to physiologic state was observed in all cases (175±12,5 nm), and in two cases signicative decrease of intraretinal lesions in neuroepithelium of macular zone. In control group only in 23% of cases macular oedema disappeared and in 27% of cases the same level of oedema was observed. Conclusions: Macular changes observed in children operated on congenital cataract necessitates corresponding correction with aim to prevent rude organic changes in neuroeithelium. Systemic enzymotherapy in children with macular changes can allow rapid and stable rehabilitation. Financial fundings: No Conflict of interest : No Keywords: Flogenzim, congenital cataract
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Abstract Book PO1-03-13 SURGICAL INTERVENTION OF COMPLICATED CATARACT IN PATIENTS WITH UVEITIS Zhang Meifen (Dep a rtment of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Eye Research Center of Chinese Academy of Medical Sciences, Beijing 100730, China), Ye Junjie (Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Eye Research Center of Chinese Academy of Medical Sciences, Beijing 100730, China), Gao Fei (Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Eye Research Center of Chinese Academy of Medical Sciences, Beijing 100730, China), Zhang Xiao (Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Eye Research Center of Chinese Academy of Medical Sciences, Beijing 100730, China), Hu Tiansheng (Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Eye Research Center of Chinese Academy of Medical Sciences, Beijing 100730, China) Objectives: To evaluate the efficacy of surgical intervention of complicated cataract in patients with uveitis. Methods: This retrospective study comprised 51 cases (69 eyes) of complicated cataract secondary to uveitis. Surgical procedures, visual outcome, postoperative recurrence of uveitis and complications were studied. Results: Phacoemulsification was done on 64 eyes (92.8%), while extracapsular cataract extraction (ECCE) was done on the other 5 eyes?7.2%). Posterior chamber intraocular lens (IOL) was implanted in 61 eyes (88.4%), while the other 8 eyes (11.6%) remained aphakia?because 6 of them were patients with the fellow eye blind. At the final follow-up, 38 eyes (55.1%) had a best corrected visual acuity of 20/40 or better. No significant difference with respect to best corrected visual acuity was found between the pseudophakia and aphakia groups. Postoperative recurrence of anterior uveitis occurred in 19 (27.5%) eyes, however, 18 of them were those eyes with IOL implant. A neodymium:YAG (Nd:YAG) laser posterior capsulotomy was performed in 24 (34.8%) eyes, however, 23 of them were pseudophakia eyes. Conclusions: Surgical intervention of complicated cataract in patients with uveitis was effective and safe. In comparison with pseudophakia group?less postoperative complications we re found in patients without IOL implantation. Accordingly, it seems feasible that cataract extraction without IOL implantation is the procedure of choice for treating uveitis patients with the fellow eye blind. Financial fundings: No Conflict of interest : No Keywords: Uveitis, Cataract, Surgery
PO1-03-14 EVALUATION OF BIO-DEPOSIT FORMATION ON INTRACORNEAL RINGS BY SCANNING ELECTRO N MICROSCOPY Ferrer Consuelo (Vissum, Instituto Oftalmologico de Alicante), Mezquida Gloria (Vissum, Instituto Oftalmologico de Alicante), Alio L Jorge (Vissum, Instituto Oftalmologico de Alicante) INTRODUCTION AND OBJECTIVES: Intracorneal ring segments (ICRS) presents few complications (e.g. extrusion). The object of this work is to report the inflammation as another complication. We present the presence of bio-deposit formation on intra-
corneal rings explanted for different causes. METHODS: Intracorneal rings (Intacs and Ferrara rings) were removed from 2 non-infected and non-inflamed eyes, 4 inflamed eyes (without infection) and 2 infected eyes. The appearance of the surface of the corneal rings was examined by scanning electron microscopy (SEM) once the corneal rings were fixed and dehydrated. Culture and PCR were carried out on the corneal samples in all cases. RESULTS: There was no evidence of bacterial biofilm formation or bio-deposits on the intracorneal rings from patients without clinical signs of infection or inflammation. Bacteria biofilm was seen on the corneal ring explanted from the patients with corneal infection and the PCR was positive for two corneal samples. Bio-deposit formation was seen on intracorneal ring explanted of inflamed eyes. CONCLUSION: There was evidence of bio-deposit formation on intracorneal rings removed from clinically inflamed eyes. There was no deposit on corneal rings explanted for caused different to inflammation. Financial fundings: None Conflict of interest : None Keywords: Intracorneal rings, inflammation, SEM
PO1-03-15 H I S TO PATHOLOGICAL A NA LYSIS OF ANTERIOR CHAMBER ANGLE STERIOD DEPOSIT AFTER INTRACAMERAL TRIAMCINOLONE INJECTION AND ROLE OF ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY IN MANAGEMENT Wong Amy Lee (The Chinese University of Hong Kong ), Yuen KL Hunter (The Chinese University of Hong Kong ), Lam SC Dennis (The Chinese University of Hong Kong ) Introduction: Use of intraocular triamcinolone acetonide injection, eiter intracamerally or intravitreally, had been advocated recently in different inflammtory eye diseases. Although many publications reported the efficacy and safty of using the commercially available steriod, up to our knowledge, there are no reports on the histological analysis of anterior chamber angle triamcinolone acetonide deposit in a health human eye after intracameral injection which was initially used to reduce the inflammation after cataract operation. Methods: Observational case report Results: The pseudohypopyon remainded static in the inferior angle for 5 weeks after the uneventful cataract operation. Histology result showed that there was foreign body reaction triggered by the unfiltered triamcinolone acetonide with evidence of histocytes surrounding the entire deposit. We also demonstrated that the Visante anterior segment optical coherence tomography could quantitatively evaluate the amount of pseudohypopyon with high resolution crossing sectional ocular imaging in a non invasive and non contact manner. Conclusion: Intracamerally injection of commercially available triamcinolone acetonide could trigger the foreign body reaction in a healthy human eye with compatible histopathological findings. Besides, important role of Visante ASOCT in management and surgical planning for this patient was highlighted here. Financial fundings: (None.) Conflict of interest : (None.) Keywords: intracameral, steroid, histology
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Abstract Book PO1-03-16 DEEP SCLERECTOMY VS TRABECULECTOMY IN UVEITIC GLAUCOMA Dupas Bénédicte (Hôpital Pitié-Salpêtri è re PARIS), Fardeau Christine (Hôpital Pitié-Salpêtrière PARIS), Cassoux Nathalie (Hôpital Pitié-Salpêtrière PARIS), Bodaghi Bahram (Hôpital PitiéSalpêtrière PARIS), Le Hoang Phuc (Hôpital Pitié-Salpêtrière PARIS) Introduction : to evaluate the efficacy and safety of deep sclerectomy with collagen implant versus trabeculectomy in patients with uveitic glaucoma. Methods : A retrospective chart review of 41 eyes from 38 patients with medically uncontrolled uveitic glaucoma. Uveitis was noted to be controlled before surgery. Patients underwent either a trabeculectomy or a deep sclerectomy with collagen implant, in both cases with intraoperative anti-proliferative agents (mitomycine C). Visual acuity, intraocular pressure, visual field, aqueous cellular score using laser flare cell meter were studied before and after surgery. In cases where reoperation was necessary or when postoperative intraocular pressure was higher than 21 mmHg, the surgery was deemed a failure. Results : The mean follow-up period was 21 ±11.3 months in patients with trabeculectomy and 19±16.5 months in patients with deep sclerectomy. The mean intraocular pressure was 12.2 ± 7 mmHg for trabeculectomy and 13.5 ± 8 mmHg for deep sclerectomy with collagen implant. The probability of success was 85 % in the trabeculectomy group and 80% in the deep sclerectomy group. Intraocular inflammation 7 days after surgery was higher with trabeculectomy than with deep sclerectomy (245.8 ph/ms vs 38.5ph/ms), but this difference was not significant after 3 months. There was a lower rate of postoperative complications with deep sclerectomy, however this group showed a greater need for complementary procedures to achieve a low pressure (subconjunctival injections, goniopuncture, or ablation of scleral flap suture). No difference was observed in term of postoperative visual acuity or visual field impairment. Conclusion : deep sclerectomy with collagen implant is another surgical treatment option in the management of uveitic glaucoma, showing pressure results comparable with trabeculectomy, but with a lower ra te of early postoperative complications and a minor intraocular inflammation. However, frequent postoperative complementary procedures are required, implying a tight follow-up. Financial fundings: none Conflict of interest : none Keywords: Uveitis, glaucoma, surgery
PO1-03-17 RISK OF REACTIVATION OF TOXOPLASMIC RETINITIS FOLLOWING CATARACT SURGERY OR PARS PLANA VITRECTOMY Oueghlani Eve lyne (Moorfields Eye Hospital, London, UK), Heringer C. Gustavo (Universidade Federal de Minas Gerais, Brazil ), Dell'Omo Roberto (Moorfields Eye Hospital, London, UK), Curi Andre (Universidade Federal de Minas Gerais, Brazil ), Pavesio E. Carlos (Moorfields Eye Hospital, London, UK) Introduction and objectives: The aim of this retrospective multicentric study conducted in two different Institutions (MEH –UK and UFMG - Brazil) is to establish the risk of reactivation of toxoplasmic retinitis following cataract surgery or pars plana vitrecto-
my in patients who had retinochoroidal scars at the time of surgery. Methods: A review of medical records of a total of 69 patients diagnosed with inactive ocular toxoplasmosis, who underwent surgery, mainly pars plana vitrectomy (ppv), but also cataract surgery. Vitrectomy surgery was performed on 65 patients and 6 patients had cataract surgery, among them 2 had a ppv at different time. These patients did not receive any antitoxoplasmic prophylactic treatment, or oral steroids before the operation. History of previous reactivations (number, duration and date of last event prior to surgery), previous therapy and characteristics of retinal lesion were recorded. Results: Follow up after ppv ranged from 2 months to 75 months with a median of 21,64 months. Reactivation occurred in 4 cases, with one at 3 months and the others respectively at 13, 14 and 17 months. Following cataract surgery, no records of any recurrence happened to be observed, on a follow up time ranging from 14 to 62 months, with a median of 34,66 months. Conclusion: Our study shows that cataract surgery and an even more invasive surgery such as ppv did not result in significant reactivation rate of toxoplasmic retinitis, in the absence of pre-operative prophylactic anti-toxoplasmic therapy. The few cases of recurrence seen, happened many months after surgery and are unlikely related to it. Our results suggest that specific prophylaxis for toxoplasmosis is not necessary for intraocular surgery in patients presenting with toxoplasmic scars, since the risk of reactivation is negligible. Use of systemic therapy, in such cases, can be avoided. Financial fundings: none Conflict of interest : none Keywords: Toxoplasmic retinitis, reactivation, surgery
PO1-04-01 FREQUENCY AND DURATION OF LONG-TERM REMISSIONS IN SEVERE OCULAR BEH?ET?S DISEASE AFTER TREATMENT WITH INTERFERON ALFA-2A Deuter Christoph M. E. (Department of Ophthalmology I, University of Tuebingen), Koetter Ina (Department of Internal Medicine II, Unive rsity of Tueb i n ge n ) , Stueb i ger Nicole (Department of Ophthalmology I, University of Tuebingen), Zierhut M a n f red (Department of Ophthalmology I, Unive rsity of Tuebingen) Introduction and objective: High recurrence rate is one reason for poor visual prognosis of ocular Behçet’s disease (BD). We evaluated the frequency and duration of long-term remissions in patients with ocular BD who were treated with interferon (IFN) alfa-2a and who completed a follow-up of at least 5 years. Methods: Twe n t y t h ree patients (41 eyes) with complete BD received IFN alfa-2a. The dosage was 6 million IU daily for at least 2 weeks, stepwise reduction to a maintenance dose of 3 million IU 2x/week, finally discontinued if possible. Previous immunosuppressives were stopped before start of IFN, steroids reduced to 10 mg prednisolone per day gradually. In case of recurrences IFN was reinstituted in the same way. Results: All 23 patients responded to IFN alfa-2a. Sixty months after initiation of IFN-therapy, 16 patients (69.6%) were without treatment. Two of these patients had a relapse after the first IFN course, but achieved complete remission after reinstitution of IFN. One of these 2 experienced a second relapse. All other 14 patients (60.9%) remained free of recurrences after one IFN course, leading to remission of at least 2 years in 43.5% and at least 3 years in 21.7%. In 7 patients IFN treatment was ongoing after 5 years. In 4
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Abstract Book patients we were unable to stop IFN. Analysing all patients after complete follow-up of mean 7.1 years (5.0-11.0 years) the relapsefree time was at least 2 years in 60.9%, at least 3 years in 52.2%, and at least 6 years in 26.1% of patients. Conclusions: In our study 69.6% of patients were free of recurrences after one IFN course during a 5-years follow-up. This has not been reported for any other BD therapy and represents a clear advantage over other anti-inflammatory drugs. Financial fundings: None Conflict of interest : None Keywords: Ocular Behcet?s Disease, Interferon alfa, Long-term Remission
PO1-04-02 CLINICAL EVALUATION OF UVEITIS WITH BEHCET DISEASE AFTER FIFTEEN YEARS FOLLOW-UP Saishin Yoshitsugu (Department of Ophthalmology, Osaka U n ive rsity Medical Sch o o l , Osaka, Japan) Ohguro Nobuyuki (Department of Ophthalmology, Osaka University Medical School, Osaka, Japan), Tano Yasuo (Department of Ophthalmology, Osaka University Medical School, Osaka, Japan) Introduction and objectives: Behcet disease (BD) is a chronic, refractory systemic disease and relapse inflammation of unknown etiology. Recurrences are common and the recurrent attacks of inflammation lead to severe and permanent ocular damage unless effective treatment is instituted. It still remains unclear until when recurrent ocular attacks could occur in BD. The aim of this study is to evaluate the long ?term prognosis for vision and the frequency of the ocular attacks with BD disease. Methods; We retrospectively reviewed the records of 52 patients (38 males, 14 females) followed up over 15 years after initial visit. We analyzed the following clinical data for each patient: gender, age at the onset of uveitis, type of uveitis, best corrected visual acuity (BCVA), frequency of ocular attacks, and the duration of follow up. Results: The total number of involved eyes was 103 (75 eyes in males and 28 eyes in females). Mean age at initial visit was 37 years old (range 21 to 57). The mean follow-up was 25 (range 15 to 48) years. Thirty-two patients (62%) were classified as complete type and 20 patients (38%) as incomplete type. While panuveitis was more common in males (91%) than in females (54%), anterior uveitis was more common in female patients (46%, 13 of 28). The mean logMAR BCVA at the last visit was 1.26 in males and 0.39 in females (Mann-Whitney Rank Sum Test, P<0.05). 35% of patients (18/52: male 12/38 and female 6/14) still had the ocular attacks after 15 years from the onset of ocular symptoms. Conclusions: Results suggest that the progression of Beh?et uveitis is worse in males. BD patients with ocular involvements should be examined carefully for a long term period. Financial fundings: none Conflict of interest : none Keywords: Behcet disease, uveitis, long term
PO1-04-03 EVALUATION OF RESISTIN AND INTERLEUKIN-6 LEVELS IN PATIENTS WITH OCULAR AND NON-OCULAR BEHCET’S DISEASE Yalc›nda Nilüfer (Ankara Unive rsity Faculty of Medicine,
Department of Ophthalmology, Turkey) Yalc›nda Ali (K›r›kkale Unive rsity Faculty of Medicine, Dep a rtment of Clinical Biochemistry, Turkey), Bat›o lu Figen (Ankara University Faculty of Medicine, Department of Ophthalmology, Turkey) ça layan Osman (K›r›kkale University Faculty of Medicine, Department of Clinical Biochemistry, Turkey), K›sa Üçler (K›r›kkale University Faculty of Medicine, Department of Clinical Biochemistry, Turkey), Özdemir Özden (Ankara Unive rsity Faculty of Medicine, Department of Ophthalmology, Turkey) Introduction and objective s : Resistin, a re c e nt ly identified adipocytokine, has been found to play an important role in inflammation. Serum resistin levels in patients with Behçet’s disease have not yet been investigated. We aimed to evaluate the relationship among resistin, interleukin-6 (IL-6 ) and other acute phase reactants, such as C-reactive protein (CRP) or alpha1-antitrypsin (·1antitrypsin). Methods: Twenty-two patients with Behçet’s disease and 8 healthy control subjects were included. While 14 patients had ocular involvement, the other 8 did not have ocular disease. Of the 14 patients who had ocular disease, 8 suffered from acute uveitis and 6 had inactive ocular involvement at study entry. CRP, ·1-antitrypsin, IL-6, and serum resistin levels were measured in all samples. Results: Resistin and alpha 1-antitrypsin levels were not different between groups. However, IL-6 (p=0.000) and CRP (p=0.000) were higher in patients with Behçet’s disease compared to the controls. In patients with Beh?et?s disease, CRP was correlated with both resistin (p=0.044), IL-6 (p=0.001) and ·1-antitry p s i n (p=0.000). In patients with non-ocular Behçet’s disease, IL-6 was correlated with both CRP (p=0.028) and ·1-antitrypsin (p=0.028), and CRP was correlated with ·1-antitrypsin (p=0.000). In patients with ocular Behçet’s disease, CRP was correlated with resistin (p=0.047), IL-6 (p=0.016) and ·1-antitrypsin (p=0.001), and resistin was correlated with ·1-antitrypsin (p=0.029). In control group, there was no significant correlation between resistin and IL6 or ·1-antitrypsin and CRP. Conclusions: Resistin concentrations in patients with Behçet’s disease do not differ from concentrations of controls. However, there is a significant positive correlation between resistin and CRP in Behçet’s patients. Serum resistin in patients with ocular Behçet’s disease correlated with both CRP and ·1-antitrypsin. Financial fundings: None Conflict of interest : None Keywords: Behçet’s disease, interleukin-6, resistin
PO1-04-04 GRANULOCYTE APHERESIS IN OCULAR BEHÇET’S DISEASE: 4 YEARS FOLLOW-UP. Garcia-Garcia Olga (hospital universitari de Bellvitge), Vidaller Palacin Antonio (hospital universitari de Bellvitge), Muñoz Joan (hospital universitari de Bellvitge), Arruga Ginebreda Jorge (hos pital universitari de Bellvitge) Mesa juan carlos (hospital universitari de Bellvitge) Introduction and objectives: In the immu n o p at h ogenesis of Behçet's disease (BD) there is gra nu l o cyte hy p e ra c t ivity, an increase in the number of granulocytes, and a high concentration of inflammatory cells. The ophthalmologic affection requires the use of corticosteroids and two or more systemic immunosuppressants
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 107
Abstract Book to prevent relapses. Granulocyte apheresis (GCAP) with cellulose acetate prodices a deplection of granulocytes and monocutes and an immunomodulation of various cytokines, reducing inflammation in the affected organs. We proved it to be effective as an induction therapy for BD in three patients resistant to conventional medical treatment, so our objective is to use it in these patients as a maintenance treatment in order to prevent relapses avoiding high prednisone levels. Methods: GCAP is an extracorporeal apheresis device. The duration of the procedure is 1 hour at a flow rate of 30 ml/min, proceeding 1800 cc of blood in each session. Informed consent was obteined from all patients previous to start the treatment. The Spanish Ministry of Health approved compassionate use for all 3 patients. After a good result with the induction treatment we used a maintenance treatment consisted in 1 monthly GCAP session during 4 years.Visual acuity (logMAR), intraocular inflammation degree and prednisone consumption were assessed in every session. Results:On completing 4 years maintenance treatment, relapses were avoided in 2 patients and decreased in 1. The average of total amount of prednisone decresed in all patients and 2 of them are controlled at the end of the study with no medical treatment. No adverse reactions were observed and the apheresisprocedure was well tolerated. Conclusions: Our results suggest clinical efficacy of GCAP in BD, measured in terms of decrease of the total amount of prednisone requirement and decrease of the number of relapses. Financial fundings: We do not have any financial funding for this research. Conflict of interest : We don't have any conflict of interest Keywords: Granulocyte, apheresis, Behçet's disease
PO1-04-05 THE NAME BEHIND THE EPONYM BEHCET: HISTORICAL DEVELOPMENT Evereklioglu Cem (Department of Ophthalmology, Division of Uvea Behcet Unit, Erciyes University Medical Faculty, Kayseri, Turkey ) , E ve reklioglu Cem (Department of Ophthalmology, Division of Uvea Behcet Unit, Erciyes University Medical Faculty, Kayseri, Turkey ) , Mirza Ertugrul Galip (Department of Ophthalmology, Division of Uvea Behcet Unit, Erciyes University Medical Faculty, Kayseri, Turkey) Introduction and Objectives: To inform the authors, investigators and journal editors about the evolution and progression of Behçet symptoms or findings chronologically by evidence–based historical articles over the years since Hippocratic writings to bring together physicians with different areas of interest within a consensus under one roof, and therefore, to address the significance of consistency on the eponym 'Behçet' among authors interested in Behçet disease care and researches, as science does not accept a 'naming dilemma'. Methods: Historical progression of Behçet disease was divided into three periods, namely pre– Behçet, Behçet, and post–Behçet. Results: Although similar symptoms and clinical findings were reported in Hippocratic writings, clear publications of the 'Triple Symptom Complex' consisting of 'Classical Triad' that indicate a new syndrome were not reported until the important publications of Dr. Hulusi Behçet. Conclusion: This article will answer the needs and questions of the authors and journal editors who feel themselves in dilemma on the eponym. Therefore, researchers should strongly be instructed to prefer the name of an old disorder well–known as 'Behçet disease'
since 1941 not only by every physician who supervise Behçet patients throughout the world, but also by medical students and even by public. Otherwise, this would lead to a needless chaos among journal editors, authors and Behçet patients who already have a difficulty in defining their illness with high morbidity from blinding ocular disease or mortality from vascular, pulmonary and neurological involvements. Key words: Behçet disease; Hippocrates; Historical Development; Hypotheses; Hulusi Behçet Financial fundings: None Conflict of interest : None Keywords: BEHCET, EPONYMAL TERMINOLOGY, HISTORY
PO1-04-07 CIRCULATING NK CELLS IN BEHCET'S DISEASE Shafi Seema A (Dept Immu n o b i o l ogy Guy’s Hospital, Kings College London); Shafi A Seema (Dept Immunobiology Guy’s Hospital, Kings College London), Stanford R Miles (Dept Ophthalmology St Thomas’ Hospital), Wallace R Graham (Academic Dept Ophthalmology, Birmingham), Hayday C Adrain (Dept Immunobiology Guy’s Hospital, Kings College London) Introduction and objectives: Behcet’s disease is a multi-organ inflammatory disease, in which the status of peripheral blood lym phoid populations has been investigated for abnormalities. While a number have been reported we decided to re-investigate the issue with specific attention paid to cells bearing NK markers. This is because evidence implicates disease associated polymorphisms in HLA and MICA molecules that cause NK cell inhibition and acti vation respectively. Methods: The peripheral blood mononuclear cells of 70 patients with BD fulfilling the ISG criteria, 30 Disease controls (a variety of posterior uveitis on equivalent doses of immunosuppression) and 30 healthy controls were stained using anti-CD16 ,CD56 and NKG2D antibodies as markers for NK cells and were analysed using FACS. The percentage of circulating NK cells from the total lymphocyte population was compared to healthy controls. Results were analysed with respect to sex, treatment and disease activity Results: It was possible to identify CD56+ CD16+ NKG2D+ cell populations in all patients, disease and healthy controls examined. However, by comparison to healthy controls, a significant number of patients showed overt abnormalities in the co-segregation of these markers. Conclusion: NK cells from BD patients exhibit abnormalities, which in part could be due to the varied cytokine milieu in patients with disease activity, with or without treatment. It is not known if these abnormalities have any effect on the function and cytotoxic potential of NK cells. This will be investigated to shed some light on whether these abnormalities are a consequence of, or contribute towards disease progression. Financial fundings: British eye Foundation Conflict of interest : (None.) Keywords: NK cells,
PO1-04-08 CHARACTERISTICS OF UVEITIS IN BEHÇET DISEASE TURKI FARES (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA), BOURAOUI RYM (HEDI RAIS INSTITUT OF OPH TALMOGY TUNISIA), LIMAIEM RYM (HEDI RAIS INSTITUT OF
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 108
Abstract Book OPHTALMOGY TUNISIA), CHAKER NIBRASS (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA), BACCOURI RAOUD HA (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA), EL MATRI LEILA (HEDI RAIS INSTITUT OF OPHTALMOGY TUNISIA) Introduction: Loss of vision in behçet disease is one of the most common, as well as one of the most serious, of its varied manifestations. The purpose of our study is to describe epidemiologic, clinical, angiographic, therapeutic and evolutive characteristics of ocular involvement of Behçet disease. Methods: From a prospective study including all cases of uveitis diagnosed between september 2003 and March 2005, we have selected 33 cases who respond to the international study group criteria of Behçet’s disease. Results: The male to female ratio was 2. The mean age was 32 years. The uveitis were bilateral in 72.7% of cases (24 patients). Panuveitis represents 54.5% of cases. Retinal vasculitis was found in 59.6 % of cases, active chorioretinitis in 33.2% of cases, papillar oedema in 29.8% of cases and macular oedema in 5.3% of cases. Uveitis was chronic in 50.9% of cases and corticoresistent in 24.6% of cases. Conclusion: The frequency of association of Behçet disease / uveitis depends on the ethnic and geographic particularities of population studied. Our study confirms the predominance of ocular manifestations in young male adult. Ocular involvement is the first manifestation of the disease in 25 to 89 % of cases (45.5 % of our patients). A non granulomatous panuveitis is the more commonly anatomopathologic form of the uveitis. An occlusive retinal vasculitis is frequently associated. Ocular involvement is a major source of serious morbidity in Behçet disease. The prognosis can be improved by a serious collaboration between internists and ophtalmologists. Financial fundings: (None.) Conflict of interest : (None.) Keywords: behcet’s disease, uveitis, vasculitis.
PO1-04-09 CYTKINE PROFILE IN ALGERIAN PATIENTS WITH BEHCET DISEASE Belguendouz Houda ("Cytokines and NOSynthases" team, Faculty of Biological Sciences, University of Sciences and Technology Houari Boumediene, A l gi e rs, Age ria) Messaoudene Djamel ("Cytokines and NOSynthases" team, Faculty of Biologi c a l Sciences, Unive rsity of Sciences and Te ch n o l ogy Houari Boumediene, A l gi e rs , A ge ria) Lahmar-Belguendouz Karima ("Cytokines and NOSynthases" team, Faculty of Biologi c a l Sciences, Unive rsity of Sciences and Te ch n o l ogy Houari Boumediene, Algiers, Ageria) Ahmedi L Mohammed ("Cytokines and NOSynthases" team, Faculty of Biological Sciences, University of Sciences and Technology Houari Boumediene, Algiers, Ageria) Hartani Dahbia (Clinique ophtalmique, CHU Mustapha Bacha, Algi e rs , A l ge ria.) To u i l - B o u ko ffa Chafia ("Cytokines and NOSynthases" team, Faculty of Biological Sciences, University of Sciences and Technology Houari Boumediene, Algiers, Ageria) Background/objectives: Uveitis is one of the major diagnosis criteria of Behçet disease (BD), a chronic inflammatory multisystemic affection with uncertain etiology. In previous study, we showed the production of gamma IFN, IL12 and IL10 during acute phases of the disease. In this study, we investigated the production of IL8, IL4 and IL18 in Algerian patients with Behçet uveitis in plasma and
Peripheral Blood Mononuclear Cells (PBMC) supernatants. Methods: 46 Algerian patients with BD (12 at inactive phase and 34 at active phase before and during cortico-therapy) and 35 control subjects were included in this study. Venous blood was obtained from patients. Plasma was collected and PBMC were separated. Cells were cultured with PHA at 10μg/ml. Cytokine concentrations were measured by ELISA sandwich kits (Immunotech, Beckman Coulter, France). Results: Patients with active disease showed significant elevation of all cytokine concentrations both in plasma and culture supernatants with or without induction compared to controls (p<0.01). Patients with inactive disease showed significant elevation of IL4, and IL18 compared to controls while there was no difference between patients and controls IL8 concentrations both in vivo and in vitro. Under therapy, patients showed significant diminution of IL8 levels in correlation with therapy duration. Conclusion: Our results showed a significant elevation of three cytokines studied during acute phases of BD compared to controls. Only IL8 concentrations were correlated with disease activity. These results reflect a TH1/TH2 profile and the inflammatory status of the disease. IL8 should be a good marker of disease activity. Financial fundings: ANDRS (Agence Nationale du Developpement de la Recherche en Santé), Algeria. Conflict of interest : (None.) Keywords: Cytokines, Behçet disease, algerian patients
PO1-04-10 PATTERN OF BEHÇET’S UVEITIS IN A REFERRAL CENTER IN TUNISIA, NORTH AFRICA Jenzeri Salah (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Ayachi Meriam (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Jelliti Bechir (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Khemakhem Riadh (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Chaouch Ahmed (Fattouma Bourguiba University Hospital, Monastir, Tunisia) K h a i rallah Moncef (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia) Introduction and objectives: To analyze the pattern of uveitis in Behçet’s disease in a referral center in Tunisia, North Africa. Method: The medical records of 62 consecutive patients (111 eyes) with Behçet’s uveitis were retrospectively reviewed. All patients fulfilled the International Study Group criteria for the diagnosis of Behçet's disease. A complete ophthalmic examination and fluorescein angiography were performed in all patients at presentation and d u ring sequential fo l l ow-up. Indocyanine green angi ograp hy (ICGA) was performed in five patients. The mean follow-up period was 6.3 years. Results: Behçet’s disease was the most common cause of uveitis (12.3 %) during the study period. Forty-seven patients (75.8%) were male and 15 (24.2%) we re fe m a l e. The mean age at the onset of uveitis was 29.9 ye a rs (range, 9 - 71 years). Uveitis was bilat e ral in 79% and unilat e ral in 21% of patients. Initial best-corrected visual acuity was worse than 20/200 in 37 eyes (33.3 %). Anatomically, panuveitis (59%) and posterior uveitis (52.6%) we re the most common forms of presentation. Retinal vasculitis was found in 89 eyes (80.2%). Ocular complications included posterior synechiae (32.7%), cataract (31.8%), cystoid macular edema (21.8%), optic at rophy (14.8%), and branch retinal vein occlusion (8.9%). All patients were t re ated with systemic and/or topical cort i c o s t e ro i d s . Immunosuppressive drugs were added in 22 patients (35.5%). Sixty-
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Abstract Book two affected eyes (55.8%) had a final visual acuity of 20/40 or better. Conclusion: In a hospital population in Tunisia, Behçet’s uveitis started frequently around the end of the third decade and had a male predominance. Bilateral panuveitis and retinal vasculitis were the most common ocular manifestations. More than 50% of patients maintained visual acuity of 20/40 or better. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Behçet's disease, Tunisia, Uveitis
PO1-04-11 CLINICAL CHARACTERISTICS OF THE BEHÇET’S DISEASE SUSPECTED PATIENTS WITH UVEITIS A kova Yonca A. (Dep a rtment of Ophthalmology, Baflkent University, Faculty of Medicine, Ankara, Turkey), Gungor Sirel G. (Department of Ophthalmology, Baflkent University, Faculty of Medicine, Ankara, Turkey) Introduction and objectives: To determine the clinical characteristics of the patients, whose ophthalmologic examination and fundus fluorescein angiography (FFA) lead to a doubt of Behçet’s uveitis at the initial examination. Methods: Retrospective evaluation of 77 eyes of 41 Behçet’s disease (BD) suspected patients with uveitis who applied to the Ophthalmology Dep a rtment of Baflkent Unive rsity Hospital between 1997 and 2007. Results: Mean follow-up was 38.12 (5-88 months). At the initial examination, anterior uveitis was noted in 68 eyes (88.31%) of 36 patients. Hypopyon was noted in only 2 eyes (2.59%) of 2 patients. The most common fundus changes were retinal infiltrate in 26 eyes (33.76%), vascular sheathing in 16 eyes (20.78%), and macular edema in 12 eyes (15.58%). Thirteen patients (31.7%) had no specific fundus change. The findings on FFA were diffuse vascular leakage in 70 eyes (90.90%), optic disc staining and dye leakage at the disc area in 66 eyes (85.71%), hyperfluorescence of the macula due to edema in 15 eyes (19.48%), cystoid macular edema in 4 eyes (5.19%), and macular ischemia in 2 eyes (2.59%). Twentyfour of the 41 patients (58.53%) were confirmed as having systemic BD by the rheumatology department. Immunosuppressive therapy was applied to 36 patients (87.80%). At the initial examination, 13 eyes (16.88) had visual acuity less than 0.1. At the last examination only 4 eyes (5.19%) had visual acuity less than 0.1. Conclusions: In patients with idiopathic uveitis, FFA findings may be important in diagnosing BD even when results of fundus examination are normal. Observing retinal vasculitis, is not only an indication to start the immunosuppressive therapy but also may be an important clue in discovering systemic BD. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Behçet’s disease, fundus fluorescein angiography, retinal vasculitis
PO1-04-12 LONGTERM EFFICACY AND SAFETY OF LOW-DOSE INTERFERON-ALPHA THERAPY IN SEVERE UVEITIS ASSOCIATED WITH BEHCET'S DISEASE Gueudry Julie (Dept of Ophthalmology, University of Paris VI Pitie-Salpetriere Hospital, Paris, France, Dept of Ophthalmology, University Hospital Charles Nicolle, Rouen, France) Wechsler
Bertrand (Dept of Internal Medicine, University of Paris VI PitieSalpetriere Hospital, Paris, France), Cassoux Nathalie (Dept of Ophthalmology, University of Paris VI Pitie-Salpetriere Hospital, Paris, France), Piette Jean Charles (Dept of Internal Medicine, University of Paris VI Pitie-Salpetriere Hospital, Paris, France), Le Hoang Phuc (Dept of Ophthalmology, University of Paris VI PitieSalpetriere Hospital, Paris, France), Bodaghi Bahram (Dept of Ophthalmology, University of Paris VI Pitie-Salpetriere Hospital, Paris, France) INTRODUCTION AND OBJECTIVES: To investigate longterm responsiveness of patients with severe uveitis associated with Behcet's disease to interferon-alpha (IFN). METHODS: Patients with panuveitis and/or retinal vasculitis, who relapsed despite steroids and immunosuppressive agents, were included in this retrospective study. IFN-alpha2 (3 million units three times a week) was administered subcutaneously. Ophthalmological examination and fluorescein angiography associated with laboratory tests were performed at regular intervals. Main outcome measures were recurrence of posterior or panuveitis attacks and decrease of oral prednisone threshold. RESULTS: Thirty-five patients were included. Median age was 30.6 years (range 11-58 years). Control of inflammation was achieved in 86% (three non-responders, two incomplete responses). One patient had a major side effect leading to permanent interferon discontinuation. Mean follow-up was 68 months (29-130). The relapse rate decreased significantly during IFN treatment: 1.6 +/-1 relapses/patient/year before IFN therapy and 0.03 +/- 0.02 relapses/patient/year during IFN therapy (p<0.0001). Median oral prednisone threshold decreased significantly from 19.7 mg/d (range 740) to 6.8 mg/d (range 2-10) (p<0.0001). Interferon was discontinued in 18 patients (67%) after 31 months of treatment (range 1650). Mean follow up after IFN discontinuation was 41 months (range 4-84). Ocular inflammation relapses occurred in 6 cases (33%) 8 months after interferon discontinuation (range 2 -20) and 3 relapses occurred during interferon tapering. The relapse rate after IFN therapy discontinuation or tapering was 0.22 +/-0.08 relapses/patient/year. CONCLUSIONS: IFN is efficient and safe for the long-term management of refractory posterior uveitis. Meanwhile it seems to be a suspensive therapeutic strategy. Financial fundings: none Conflict of interest : none Keywords: Behçet disease, uveitis, interferon-alpha
PO1-04-13 THE DY NAMIC EXPRESSION OF CXCR2 ON NEUTROPHILS IN PATIENTS WITH OCULAR BEHCET'S DISEASE Sonoda Koh-Hei (Graduate School of Medical Sciences, Kyushu University), Ariyama Akiko (Graduate School of Medical Sciences, Kyushu University), Ishibashi Tatsuro (Graduate School of Medical Sciences, Kyushu University) Introduction and objective: CXCR1 and CXCR2 are members of the CXC chemokine receptor family, and belong to the ELR-positive chemokine receptor group. Both receptors are known to be crucial for both recruitment and activation of neutrophils through binding CXC chemokines. It is known there are many neutrophils in inflammatory foci in Behcet’s disease (BD). We thus decided to measure the levels of the CXCR1 and CXCR2 consecutively on cir-
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Abstract Book culating neutrophils of patients suffering from ocular BD. Methods: Peripheral blood leukocytes were harvested from healthy volunteers (n=10) and ocular BD patients (n=47) during June 2004 to March 2006. The expressions of the CXCR1 and CXCR2 on neutrophils were consecutively analyzed by flow cytometry and measured the mean fluorescence intensity (MFI) on each time point. The mean and dispersion of MIF values for individual person were compared between healthy volunteers and BD patients. Results: Both healthy volunteers and BD patients constitutively express CXCR1 with high MIF without any difference. Although the CXCR2 on healthy volunteers were constantly expressed with low MIF, the CXCR2 levels in BD patients had dynamically varied during the examined term. Both mean and dispersion of CXCR2 MIF in BD patients were higher than that of healthy volunteers. Furthermore, there was the tendency that the CXCR2 showed high level just before ocular attacks and became lower levels at the very time of ocular attacks. Conclusions: In contrast to the static expression of CXCR1, we confirmed the dynamic expression of CXCR2 on neutrophils in BD patients. We also found transient elevation of CXCR2 on neutrophils was preceded on each ocular attack. CXCR2 may play a potential role to induce ocular attack of BD disease. Financial fundings: none Conflict of interest : none Keywords: Behcet's disease, chemokine, neutrophil
PO1-05-01 A ROLE OF MU-CRYSTALLIN IN ENDOTOXIN-INDUCED UVEITIS Imai Hiroki (Department of Ophthalmology, Shinshu University School of Medicine) Ohta Kouichi (Department of Ophthalmology, Shinshu Unive rsity School of Medicine), Yoshida Akiko (Department of Ophthalmology, Shinshu University School of Medicine), Suzuki Satoru (Aging Medicine and Geriatrics, Aging and Adaptation, Shinshu University Graduate School), Kikuchi Ta k a n o bu (Research Center for Human and Envviromental Science) Introduction and objectives: Mu-Crystallin (CRYM) was first identified as a major structural protein of lens. We have previously reported that CRYM highly expressed in iris-ciliary body (ICB) of endotoxin-induced uveitis(EIU) rats by cDNA microarray analysis. This indicated that CRYM probably had non-crystallin role, like other crystallins. The purpose of this study was to examine a possible role of CRYM in EIU. Methods: EIU was induced by a footpad injection of lipopolisaccaride (LPS) in male Lewis rats (6-8 week). The expression level of CRYM expression in the ICB at each time point (3, 6, 12, 24) after LPS injection was studied by real time RT-PCR and Western blot analysis. Immunohistochemical studies were also performed to localize CRYM. Eyes of wild-type mice and CRYM deficient (CRYM-KO) mice were enucleated on 5 days after LPS injection. Inflammatory cells infiltrated into the anterior chamber (AC) were counted on histological sections of eyes. Results: CRYM mRNA was up-regulated in the ICB at 6, 12 hours after LPS injection. CRYM protein up-regulated at 12, 24, 48 hours after LPS injection, and identified in the non-pigment ciliary epithelium. The number (mean ? S. E. M) of inflammatory cells infiltrated into the AC of CRYM-KO mice were significantly less than those of wild-type mice (17.9 ? 1.6, 27.1 ? 2.4 cells/section, respectively p = 0.006).
Conclusions: CRYM was expressed in the non-pigment ciliary epithelium in EIU. Intraocular inflammation in CRYM-KO mice was milder compared with that in wild-type mice. These results suggested CRYM might play a role in late inflammation. Financial fundings: N/A Conflict of interest : N/A Keywords: endotoxin-induced uveitis, mu-crystallin, ciliary body
PO1-05-02 MECAHNISM OF APOPTOSIS IN CULTURED HUMAN LENS EPITHELIAL CELLS BY UV IRRADIATION Koh Jae Woong , Yang Yoo Ri INTRODUCTION: To determine the mechanism of apoptosis by UV irradiation in cultured human Lens epithelial cells. Method : Cultured human Lens epithelial cells were irradiated with a UV lamp for 30 seconds, p53, Caspase-3 and NOXA were measured by Western blot. Results : p53 became inactive from 85 to 54, in case of Caspase from 95 to 47, but NOXA was shown active from 54 to 163 apparently. ConclusionS : This finding suggest that the mechanism of apoptosis by Ultraviolet in cultured human Lens epithelial cell is induced by dysfunction of mitochondria associated with NOXA that is independent of p53. Financial fundings: (None.) Conflict of interest : (None.) Keywords: HUMAN LENS EPITHELIAL CELL, UV IRRADIATION
PO1-05-03 EXPRESSION A NA LYSIS OF CYTOKINE AND CHEMOKINE GENES DURING THE DEVELOPMENT OF MURINE EXPERIMENTAL AU TOIMMUNE UVEORETINITIS Hashida Nori yasu , (Department of Ophthalmology, Osaka U n iversity Medical Sch o o l , Osaka, Japan) Ohguro Nobuyuki (Department of Ophthalmology, Osaka University Medical School, Osaka, Japan), Tano Yasuo (Department of Ophthalmology, Osaka University Medical School, Osaka, Japan) Objective: The aim of this study was to investigate the sequential expression changes of cytokines/chemokines and their receptors during development of murine experimental autoimmune uveoretinitis (EAU). Methods: EAU was induced in C57BL/6 mice. From immunization to day 23, RNA was isolated daily from the eyes of EAU mice. Dynamic changes in 96 selected genes were analyzed during the pathogenesis of EAU by TaqMan Gene Expression Assay (low density array) that contained most chemokines/cytokines and their receptors, with beta-actin as the endogenous control. Data comparison between the peptide-injected group and the placebo-injected group was performed. All procedures, including data analysis, were performed on the Applied Biosystems PRISM 7900 Sequence Detector. Gene clusters based on expression profiles were analyzed to determine candidate genes that participated in the pathogenesis of inflammation. Results: Gene expression changed dramatically from the beginning of immunization. Hierarchical cluster analysis also discriminated
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Abstract Book three distinct changes on a daily basis (early, intermediate, and active phases). Gene expression changes in the active phase of EAU displayed biphasic patterns: gene up-regulation including interferon-gamma and chemokine (C-X-C motif) ligand 9 at the peak of inflammation (16-18 days after peptide inoculation) and transient overexpression of several genes at 20 days. Conclusion: Dynamic ex p ression changes of cytokine and chemokine genes indicate possible participation in the pathogenesis of EAU. In biphasic expression changes at the peak of inflammation, it is likely that one distinct peak (16-18 days) showed upregulation of inflammatory genes as the result of EAU. Another peak (20 days) revealed transient expression changes of several genes for an antiinflammatory effect, indicating the importance of sequential changes of inflammatory gene expression in the pathogenesis of EAU. Cluster analysis of comprehensive gene expression during EAU may provide a novel therapeutic approach to determine the targets by which to control ocular inflammation. Financial fundings: This study was supported by Grant-in-Aid C17591834 for Scientific Research from the Ministry of Education, Culture, and Science(SY), Japan Conflict of interest : None Keywords: EAU, gene expression, cluster analysis
PO1-05-04 PATHOGENESIS OF OCULAR INFECTION: HOW FUNGI INVADE THE EYE Wilhelmus Kirk R. (Baylor College of Medicine) Jackson Beth (Baylor College of Medicine) Mitchell Bradley (Baylor College of Medicine) Introduction and Objectives: Fungi are normal commensals that can become pathogenic opportunists. Our previous studies showed that the immune status and genetic background determine the host?s susceptibility to experimental fungal infection of the eye. We have now examined how fungal virulence factors contribute to ocular infection after injury. Methods: After scarification of the corneas of BALB/c mice, eyes were topically inoculated with Candida albicans. Fungal strains included wild-type isolates and transposon-generated mutants having genetically altered adherence or filamentation. For selected fungal strains showing attenuated pathogenicity, genetic rescuants of null mutants created by plasmid integration were also assessed for ocular virulence. Infected and control mice were monitored daily for severity of fungal keratitis, and eyes were examined by histopathology. Results: A wild-type human isolate caused severe, sustained infl a m m ation. Funga l knockouts lacking genes involved in adherence were similarly pathogenic for the traumatized eye. However, candidal strains deficient in genes involved in the phenotypic transformation from yeasts to hyphae showed partial or complete inability to invade the corneal stroma and to enter the anterior chamber. Fungal genes affecting the clinical severity of experimental murine keratomycosis included rim13, rbt4, efg1, sap6, sal2, mds3, sch9, and suv3. Genetic reconstitution of a deleted virulence gene restored pathogenicity. Conclusions: Fungi such as C. albicans use virulence pathways to infect the traumatized eye. The genetically controlled ability to develop filamentous forms appears necessary for fungi to invade ocular tissues. We hypothesize that the rim101-dependent and tup1-regulated pathways control the morphogenic switch from blastoconidia to hyphae of C. albicans and, along with one or more efg1-regulated secreted aspartyl proteinases, are crucial for fungal invasion of the external eye. Understanding the molecular dynam-
ics of fungal morphogenesis may offer new opportunities in the prevention and therapy of infectious diseases of the eye. Financial fundings: National Eye Institute, Sid W. Richardson Foundation, Lions Eye Bank Foundation Conflict of interest : None Keywords: Fungi, Keratitis, Mycosis
PO1-05-05 REGULATION OF THE OCULAR CD36 GENE BY HYPOXIA. Mwaikambo Bupe (Dept. of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada), Chemtob Sylvain (Dept. of Pharmacology & Therapeutics, McGill University, and Dept. of Pediat ri c s , O p t h a l m o l ogy & Pharm a c o l ogy, Unive rsity of Montreal, Montreal, Quebec, Canada), Hardy Pierre (Dept. of Pediat ri c s , O p t h a l m o l ogy & Pharm a c o l ogy, Unive rsity of Montreal, Montreal, Quebec, Canada) Introduction and objectives: CD36, a class B scavenger receptor, binds to numerous ligands including oxidized low density lipoproteins (oxLDLs) and apoptotic cells. We recently reported that corneal injury and ensuing neovascularization induces elevated levels of CD36 as part of a pronounced inflammatory response. Given that inflammation and hypoxia typically occur concomitantly, we hypothesized that hypoxia modulates CD36 expression and function. Methods and Results: Quantitative real time RT-PCR (qRT-PCR) analysis of corneal and retinal tissue from hypoxia exposed mice (8% O2, 6h) revealed a 3.5- and 6-fold increase in CD36 mRNA respectively. Subsequent experiments on human retinal pigment epithelial cells (ARPE) indicated that hypoxia (2% O2) induced a time-dependent increase in CD36 mRNA, protein, and surface expression. Using specific inhibitors of mRNA transcription (actinomycin D) and translation (cycloheximide), we demonstrated that the hypoxia-induced CD36 expression was a consequence of increased protein synthesis, but not elevated mRNA or protein stability. Consistent with this, inhibitors of phosphatidylinositol-3kinase (PI3K; wortmannin, LY294002), a known translational regulator, abolished the CD36 hypoxic signal. The mechanisms regul ating CD36 under hy p oxia we re further characteri zed using inhibitors of the major cellular sources of reactive oxygen species (ROS). Blockers of NADPH oxidase (apocynin), lipid peroxidation (U74389G, tempol), and the mitochondrial electron transport chain (rotenone, 3-nitropropionic acid, myxothiazol) significantly attenuated the hypoxia-induced CD36 mRNA levels. Intriguingly, the functional ramifications of CD36 overexpression during hypoxia were evinced by CD36 specific augmentations in DiI-oxLDL internalization and apoptotic cell phagocytosis. Conclusions: The current findings provide unique insight into a previously undisclosed induction of CD36 by hypoxia that appears to be transmitted through a transcriptional and translational mechanism requiring activation of PI3K and generation of ROS. Of relevance, overexpression of CD36 during hypoxia seems to augment its scavenging activity, particularly the uptake of oxLDLs and phagocytosis of apoptotic cells. Financial fundings: Foundation Fighting Blindness-Canada and Canadian Institute of Health Research Conflict of interest : I have nothing to disclose Keywords: CD36, hypoxia, free radicals
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Abstract Book PO1-05-07 DELETERIOUS EFFECT OF NITRIC OXIDE DERIVATES ON OCULAR EXPLANTS IN VITRO. Belguendouz Houda ("cytokines & NOSynthases" team, Laborat o ry of Cellular and Molecular Biology, Faculty of Biological Sciences, U S T H B, Algiers, Alge ria) Lahmar-Belguendouz Karima ("cy t o k i n e s & NOSynthases" team, Laborat o ry of Cellular and Molecular Biology, Faculty of Biological Sciences, USTHB, Algiers, Algeria) Belguendouz Houda ("cytokines & NOSynthases" team, Laborat o ry of Cellular and Molecular Biology, Faculty of Biological Sciences, USTHB, Algiers, Alge ria) Messaoudene Djamel ("cytokines & NOSynthases" team, Laboratory of Cellular and Molecular Biology, Faculty of Biological Sciences, U S T H B, Algiers, Algeria) Ahmedi Laid Mohammed ("cytokines & NOSynthases" team, Laborat o ry of Cellular and Molecular Biology, Faculty of Biological Sciences, U S T H B, A l gi e rs , A l ge ria) Touil - Bouko ffa Chafi a ( " cytokines & NOSynthases" team, Laborat o ry of Cellular and Molecular Biology, Faculty of Biological Sciences, U S T H B, Algiers, Algeria) Background/Objectives: Several studies showed important nitric oxide production during intraocular inflammation. This highly reactive molecule has a very short life time and reacts rapidly with oxygen species to give the more reactive molecule, peroxynitrite, and its end products, nitrites and nitrates. In a previous study, we showed cytotoxic effect of nitrites and nitrates on bovine retina in vitro. In this study, we investigated the effect of these two molecules and peroxynitrites on ocular explants in vitro. Methods: After clinical examination, healthy bovine eyes were obtained immediately after enucleation and were transported to the laboratory at +4°C. After dissection, ocular explants from anterior and posterior segments were cultured in DMEM supplemented with 2mM glutamine, 100 UI of penicillin and streptomycin. Cultures were treated with either nitrites or nitrates at different concentrations (100500μM). After culture incubation (24-48 h), ocular explants were fixed in buffered formalin, histological study was performed. Results: All structures showed structural alterations in relation with culture duration and molecule concentrations. The different structures showed different degree of sensibility depending on molecule nature and concentration. Peroxynitrites induced the highest degree of disorganization at very low concentrations. According to our previous study, nitrites showed more cytotoxic effect than nitrates. Sclerotic showed very little responses to the different molecules while retina showed the highest sensibility. Conclusion: Our results showed high cytotoxic effect of peroxynitrites, nitrites and nitrates on ocular structures in vitro. This effect was correlated with molecule concentration and exposition duration. Structure alteration observed suggests nitric oxide, via its products, is implicated in ocular lesions observed during ocular affections. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Nitric oxide, Eyes, Alteration
PO1-05-08 EXPRESSION OF AQUAPORINS IN THE RETINAL PIGMENTED EPITHELIAL ARPE-19 CELL LINE Sarah Janssens1, Laure Caspers2, Francois Willermain2, Christine Delporte1 1Laboratory of Biological Chemistry and Nutrition, Université L i b re de Bruxelles, Brussels, Belgium, 2Dep a rtment of Ophthalmology, CHU Saint-Pierre and Brugmann, Brussels, Belgium
Introduction and objectives: The mechanisms regulating the degree of hydration of the external retina are still poorly understood. Several ionic pumps have been shown to play a pivotal role in the transcellular osmotic gradient in the retinal pigmented epithelium (RPE) formed by tight junctions. Aquaporins (AQPs), transmembrane proteins facilitating transcellular water transport following osmotic gradients, could also be involved in the external retina hydration. We studied the expression of several aquaporins in the retinal epithelial cell line ARPE-19. Methods: The expression of AQP1, AQP4, AQP5 and AQP6 in ARPE-19 cell line was determined by Western blot analysis and immunofluorescence. Results: P rotein immu n o blots of membranes from ARPE-19 revealed the 30 kDa band, corresponding to the expected molecular±presence of a weight of AQPs observed in kidney (AQP4) and p a rotid (AQP5) membranes used as positive control. Pro t e i n immunoblots of total proteins from ARPE-19 revealed the presence of a ± 30 kDa band corresponding to the expected molecular weight of glycosylated form of AQP6 observed in kidney (which showed an additional band of ± 28 kDa corresponding to the unglycosylated form of AQP6). No detectable band could be observed for AQP1 in ARPE-19 membranes. Similarly, immunofluorescence analysis confirmed the presence of AQP4, AQP5 and AQP6 and the absence of AQP1 in the ARPE-19. Conclusions: The retinal pigmented epithelial ARPE-19 cell line constitutive lyex p resses AQP4, AQP5 and AQP6. These aquap o rins could have a predominant role in the water transport accross the RPE. Financial fundings: Fond National de la Recherche Scientifique (Belgium) Conflict of interest : No conflict of interest Keywords: aquaporin, retina, hydration
PO1-05-09 THE DISTRIBUTION OF UVEITOGENIC GFP+ T CELLS IN A RAT MODEL OF UVEITIS Th u rau Stephan R. (Section of Immu n o b i o l ogy, Dept. of Ophthalmology, Ludw i g - M a x i m i l i a n s - U n ive rs i t y, M u n i ch , Germany), Diedrichs-Möhring Maria (Section of Immunobiology, Dept. of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany), Hoffmann Christiane (Section of Immunobiology, Dept. of Ophthalmology, Ludw i g - M a x i m i l i a n s - U n ive rs i t y, M u n i ch , Germany), Wildner Gerhild (Section of Immunobiology, Dept. of Ophthalmology, Ludw i g - M a x i m i l i a n s - U n ive rs i t y, M u n i ch , Germany) Introduction and objectives: In Lewis rats experimental autoimmune uveitis (EAU) can be induced by adoptive transfer of retina specific CD4+ T cells. In order to investigate the fate of uveitogenic T cells after ocular inflammation, during spontaneous relapses as well as during e xperimental reinduction of disease and after extended remission we injected GFP-transduced CD4+ T cell lines specific for the IRBP-peptide R14 in rats that developed uveitis 56 days later. Methods: At day 27 these rats were immunized with peptide R14 in CFA to induce a relapse around day 35. In another experiment GFP+ CD4+ T cells specific for Ovalbumin (OVA) were adoptively transferred to Lewis rats. Nine days later rats were immunized with retinal peptide PDSAg in CFA to induce uveitis. Eyes, lymph nodes and spleens were collected at different time points. Results: Six weeks after transfer GFP+ T cells of either specificity were observed in the retinas. In eyes with uveitis - either after spon-
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Abstract Book taneous or induced relapse - the numbers of intraocular GFP+ cells increased slightly. Clusters of retina-specific GFP+ T cells were detectable, suggesting clonal expansion or focal attraction of new GFP+ cells invading from the periphery, whereas in clinically quiet eyes single GFP+ cells were distributed within the retina. OVA-specific T cells also migrated into the retina independently of EAU development, but never formed clusters. GFP+ cells were also found in the T cell areas of peripheral lymph nodes (inguinal, mesenteric) and spleens after more than 5 weeks. Conclusions: Activated T cells of any specificity can invade the ocular tissues and remain viable within the eyes and lymphoid tissues for an extended time period without undergoing apoptosis. They are recruited to the eye from the periphery during a secondary disease course, but may also clonally expand in situ after antigen-specific stimulation. Financial fundings: Sonderfo rs ch u n g s b e re i ch 571, Deutsche Forschungsgemeinschaft DFG Conflict of interest : None Keywords: Uveitis rat model, Green fluorescent protein, T cells
PO1-22-01 PUNCTATE INNER CHOROIDOPATHY AND CHOROIDAL NEOVASCULARIZATION IN A HLA-B27 POSITIVE PATIENT WITH ANTERIOR FIBRINOUS UVEITIS Quek Desmond Tung-Lien (Singapore National Eye Centre), Cheng Ching Li Bob (Singapore National Eye Centre), Chee Soon Phaik (Singapore National Eye Centre) Introduction: Punctate inner choroidopathy (PIC) typically presents in young myopic women with decreased visual acuity and metamorphopsia. Classically, small creamy yellow choroidal and retinal pigment epithelial lesions are seen, without signs of inflammation. We report an unusual case of PIC in a patient with HLAB27 associated anterior uveitis, complicated by inflammatory choroidal neovascularization (CNV), which resolved without treatment. Methods: Case report. Results: A 23 year-old female with moderate myopia presented with acute fibrinous anterior uveitis with anterior chamber cells, flare, hypopyon and scleritis. A few pale yellow, juxtafoveal, subretinal lesions were noted, with no vitritis, retinitis or vasculitis. She was HLA-B27 positive but anti-nuclear antibody, anti-double stranded deoxyribonucleic acid antibody, venereal disease research laboratory, syphilis line immunoassay, chest X ray and Mantoux tests were negative. She was treated with topical steroids with resolution of inflammation. The juxtafoveal subretinal lesions subsided, with residual mottling of the macula. Fifteen months later, she presented with metamorphopsia of the right eye. Anterior segment examination was unremarkable. There were multiple pale yellow, juxtafoveal, subretinal lesions with an area of subfoveal intraretinal and subretinal blood in the right eye, with similar pale yellow lesions, without bleeding, in the left. On fluorscein angiography, the lesions demonstrated early hyperfluorescence, with moderate leakage in the late phases representing classic choroidal neovascularization. She was offered treatment with peri-ocular and systemic steroids but opted for observation without any treatment. Over four months, the lesions developed into atrophic pigmented scars, with best corrected visual acuity stabilizing at 6/12 in the right and 6/6 in the left. Conclusion: PIC is a rare clinical entity, and has not been previously reported to occur with anterior uveitis, nor be associated with
HLA-B27 allele. CNV, which develops in 25% to 40% of cases, can be treated with peri-ocular or systemic steroids, or spontaneously resolve. Financial fundings: None Conflict of interest : None Keywords: Punctate inner choroidopathy, HLA-B27, choroidal neovascularization
PO1-22-02 INTRAVITREAL BEVACIZUMAB FOR REFRAC TO RY CHOROIDAL NEOVASCULARISATION (CNV) SECONDARY TO UVEITIS TRAN Thi Ha Chau (H么pital Saint Vincent de Paul, Lille, France) Fardeau, Christine (Groupe Hospitalier Pitie Salpetriere, Paris, France), Bodaghi Bahram (Groupe Hospitalier Pitie Salpetriere, Paris, Fra n c e ) , LeHoang Phuc (Groupe Hospitalier Pitie Salpetriere, Paris, France) Introduction : Choroidal neovascularisation is a rare complication of uveitis with low grade inflammation. Corticosteroids and photodynamic therapy are efficient in most cases of inflammatory CNV. New medications targeting vascular endothelial growth factor are promising in the treatment of wet macular degeneration. Objectives: This study describes the clinical response, angiography and OCT findings in patients with refractory CNV secondary to uveitis who were treated with intravitreal bevacizumab. Methods: A retrospective analysis data for 4 patients with inflammatory CNV, initially treated with systemic steroids and photodynamic therapy. All patients were refractory to previous treatment. They received intravitreal bevacizumab then were followed by clinical examination, angiography and OCT. Results: The aetiology of CNV was multifocal choroiditis in all cases. All patients had stable or improved visual acuity. Resolution of leakage from the CNV was obtained in two cases. Leakage was decreased but remained active in two cases. Conclusions: Intravitreal bevacizumab may be a possible option in the treatment of refractory inflammatory CNV. Evaluation of a larger study and a longer follow-up is needed Financial fundings: (None.) Conflict of interest : (None.) Keywords: choroidal neovascularisation, uveitis,bevacizumab
PO1-22-03 INTRAVITREAL BEVACIZUMAB IN THE TREATMENT OF CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH SARCOID PANUVEITIS Casado Blanco Alvaro (H.C.U. de la Princesa, Madrid), Gonzalez Guijarro Juan Jacobo (Vissum Madrid Corp o ra c i o n Oftalmologica), Casado Blanco Herman (hospital General Rio Carrion, Palencia) Introduction: To describe our ex p e rience with intravitreal Bevacizumab in a patient with active sarcoidosis panuveitis and subfoveal choroidal neovascularization (CNV) Case Report: A 70 years old female with medical history of sarcoidosis since 1999, and a chronic bilateral panuveitis, was being treated with tapered oral corticosteroid short courses. Multiple systemic risk factors (uncontrolled systemic hypertension, hepatic cholestasis, obesity,diphenylhydantoin therapy) made it difficult to
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Abstract Book associate inmunosuppressants. In 2003, she developed a classic subfoveal CNV in her right eye. Visual Acuity (VA) was 0.062. Oral corticosteroids (1 mg/Kg/day) and two intravitreal injections of 4 mg triamcinolone were carried out, obtaining CNV fibrosis with VA stabilization. Three years later, a classic subfoveal CNV appeared in her left eye, soon after withdrawal of cyclosporine and corticosteroid systemic therapy secondary to acute pancreatitis and hepatic cholestasis. VA was 0.125. Treatment with oral corticosteroids (0.5 mg/Kg/day), cyclosporine (5 mg/Kg/day) and two injections of 20 mg intravitreal triamcinolone at a two month interval failed to inactivate the CNV, although improvement of VA (0.15) was achieved. OCT and fluorescenin angiography showed retinal edema and CNV activity. After three intravitreal bevacizumab doses (1.25mg in 0,05 ml) at a month interval, VA improved up to 0.2, whilst OCT retinal thickness was slightly reduced. No potential adverse effects (inflammation or ocular toxicity) were observed. Conclusions: although controlling inflammation with corticosteroids and immunosuppressants has always been advocated as a first step to treat CNV associated with active uveitis, in our experience, this is not always enough, and adding other therapies seems to be necessary. This is far more difficult in pluripathologic patients not suitable for laser or surgical treatments. In our experience, Bevacizumab has a slow but effective and safe action in stabilizing this kind of lesions. Financial fundings: Vissum Madrid Corporaci?n oftalmol?gica Conflict of interest : (None.) Keywords: Choroidal neovascularization, panuveitis, bevacizumab
PO1-22-04 EXUDATIVE HEMORRHAGIC MACULOPATHY IN OCULAR LYME BORRELIOSIS Amer Radgonde (Aberdeen Royal Infirmary, Aberdeen, Scotland), Brannan Suzanne (Aberdeen Royal Infirmary, Aberdeen, Scotland), Forrester V John (Aberdeen Royal Infirmary, Aberdeen, Scotland) Introduction: Lyme disease is a multisystemic disease, caused by the tickborne spirochaete Borrelia burgdorferi. The spectrum of ocular borreliosis includes interstitial keratitis, anterior uveitis, vitritis, choroiditis, retinal vasculitis and optic neuritis. We describe the occurrence of inflammatory choroidal neovascular membrane (CNVM) in two patients suffering from Lyme disease. Methods: Descriptive review of the clinical records of two patients treated for ocular lyme borreliosis at the department of ophthalmology at Aberdeen Royal Infirmary in Scotland. Results: The first patient was a 16-year old healthy male who reported being exposed to a tick bite three months earlier. Visual acuity was CF OD and 6/6 OS. He had vitritis with marked papillitis and an exudative elevated subretinal macular lesion in his RE. Retinal vasculitis was observed in both eyes. Despite negative lyme serology, treatment was started with IV ceftriaxone and a week later pulse-therapy with IV methylprednisolone was administered with a tapering dose of oral steroids thereafter. Three months later RE VA had improved to 3/60. The second patient was a 38-year old healthy female who presented with reduced left eye vision 6 weeks post tick-bite. She also suffered from erythema migrans and arthra l gias. Examination revealed vitreous snowballs, swollen optic disc and few retinal hemorrhages in the macula with vascular sheathing. Treatment was started with IV ceftriaxone. One month later there was profound loss of vision with development of subretinal choroidal neovascu-
lar membrane. Treatment was declined by the patient and eventually retinal fibrosis developed. Conclusions: Inflammatory choroidal neovascular membrane has not been previously described in the setting of ocular Lyme borreliosis. We herein describe the occurrence of inflammatory CNVM in two patients whose diagnosis with Lyme disease was clinicallybased as both were sero-negative. Visual outcome in the two patients was profoundly impaired due to the ensuing macular scar. Financial fundings: none Conflict of interest : none Keywords: LYME DISEASE, MACULOPATHY, CHOROIDAL NEOVASCULAR MEMBRANE
PO1-22-05 LONG TERM OUTCOME OF INFLAMMATORY MACULAR CHOROIDAL NEOVASCULARIZATION Fardeau Christine (Dep a rtment of Ophthalmology, PitiéSalpêtrière Hospital, Unive rsity Pa ris VI, Paris) Tran Chau (Dep a rtment of Ophthalmology, Pitié-Salpêtrière Hospital, Unive rsity Pa ris VI, Paris) LeTien Va l é rie (Department of Ophthalmology, Pitié-Salpêtrière Hospital, University Paris VI, Paris), Ducos Ghislaine (Department of Ophthalmology, PitiéSalpêtrière Hospital, University Paris VI, Paris), Bodaghi Bahram (Dep a rtment of Ophthalmology, Pitié-Salpêtrière Hospital, U n iversity Pa ris VI, Pa ri s ) , LeHoang Phuc (Dep a rtment of Ophthalmology, Pitié-Salpêtrière Hospital, University Paris VI, Paris) Introduction: The therapeutic management of choroidal neovascularisation (CNV) sigh threatening complication of posterior uveitis, include immunosuppressive therapy, laser photocoagulation, photodynamic therapy, surgical removal, antiVEGF intravitreal injection and combination of different options. We report the visual outcome in a longitudinal cohort of patients presenting inflammatory CNV. Methods: Patients with active inflammatory CNV recruited from 1st January 1998 to 1st November 2006 and followed at least 8 months were retrospectively reviewed. Steroid therapy was the first line treatment in the management. Second line treatment was Krypton photocoagulation for extrafoveal CNVor phototherapic therapy for juxta and subfoveal CNV. Intravitreal bevacizumab was used as third line treatment in recent cases. Successful treatment was defined as improvement of best corrected visual acuity at least of 2 lines and no persistence of angiographic leakage. Results: 43 consecutive patients with 49 involved eyes were included. First line steroid therapy was used in 44 eyes of 39 patients. It was successful in 17/44 eyes (42%).The CNV remained active in 27 eyes. Of these cases, the CNV was extrafoveal in 7 eyes and juxtafoveal or subfoveal in 20 eyes. Krypton photocoagulation was successful in 6/7 extrafoveal CNV. Of 20 juxta or subfoveal CNV cases treated with photodynamic therapy, 13 (65%) were successful with 1.8 mean treatments, 7 were unsuccessful. Two of theses received intravitreal bevacizumab, the last five eyes had a severe visual acuity loss and did not require further treatment. Five eyes (5 patients) were treated with photodynamic therapy alone as first line treatment before being referred, it resulted in growing of the active CNV area in all cases Conclusion: Combination of steroid and photocoagulation and/or photodynamic therapy may be useful in the treatment of inflammatory CNV. Further studies are needed to determine the place of antiVEGF intravitreal injection in the management of inflammato-
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Abstract Book ry CNV . Financial fundings: none Conflict of interest : None Key wo rd s : choroidal neovascularization treatment, p o s t e ri o r uveitis, long term outcome
PO1-22-06 MACULAR SUBRETINAL NEOVASCULARIZATION IN SERPIGINOUS-LIKE CHOROIDITIS TREATED WITH BEVACIZUMAB: CASE REPORT. Garcia Carlos Alexandre (University Federal of Rio Grande do Norte), Segundo Souza Paulo (University Federal of Rio Grande do Norte), Garcia Filho Alexandre Carlos (University Federal of Sao Paulo), Garcia Claudia Me Ana (University Federal of Rio Grande do Norte) Context: Serpiginous choroiditis is a rare and recurrent eye disorder characteri zed by irreg u l a rly shaped (serp i ginous) lesions involving the retinal pigment epithelium and the choriocapillaris. The evaluation of this disease can be complicated by the development of subretinal neovascular membrane. Case Report: A 45-yearold female presented with decreased vision in her right eye for 7 days. A serpiginous-like scar towards the macula was observed and the fluorescein and OCT showed macular subretinal hemorrhage and neovascular membrane .The exams were negative for tuberculosis and sarcoidosis. Intra-vitreous bevacizumab injection was administered twice over a 30-day interval. Initial visual acuity was 20/400 and six months later 20/15, without vessel leakage at angiogram. Comments: The use of anti-VEGF (bevacizumab) may improve visual acuity in patients with early diagnosed serpiginouslike choroiditis complicated by choroidal neovascularization. Financial fundings: (None.) Conflict of interest : the authors do not any financial interest Keywords: Serpiginous choroiditis, Subretinal neovascular membrane, Bevacizumab.
PO1-22-07 INTERMEDIATE UVEITIS COMPLICATED BY CHOROIDAL GRANULOMA FOLLOWING SUBRETINAL NEOVASCULAR MEMBRANE: CASE REPORT. Garcia Carlos Alexandre (University Federal of Rio Grande do Norte), Garcia Filho Alexandre Carlos (University Federal of Sao Paulo), Garcia Claudia Me Ana (University Federal of Rio Grande do Norte), Segundo Souza Paulo Introduction: choroidal neovascularization is a very rare complication in intermediate uveitis. Case reports: (1) A 27 year-old female patient diagnosed with intermediate uveitis two years ago. She presented with 20/200 visual acuity, snowballs, snowbanks, and macular cystoid edema in the right eye observed by fluorescein and OCT. Photocoagulation was performed in the inferior peripheral retina in both eyes. The patient refused to undergo the prescribed clinical treatment. She returned twelve months later presenting with count fingers visual acuity, dry retina and subretinal macular pigmented granuloma observed at OCT. (2) A 15 year-old female patient with decreased visual acuity of 20/400 in the right eye f or eight days. She presented with bilateral vasculitis and papilitis in the right eye, hemorrhage and extramacular subretinal neovascular membrane observed at fluorescein and OCT. She was
treated with 40 mg prednisone and intra-vitreous injection of 1.25 mg bevacizumab. Five months later she presented with 20/50 visual acuity, and ex t ramacular gra nuloma observed at OCT. Comments: The formation of subretinal granuloma in intermediate uveitis is a possibility when complicated by subretinal neovascular membrane. Financial fundings: (None.) Conflict of interest : The authors do not any finalcial interest Keywords: Subretinal neovascular membrane, intermediate uveitis, bevacizumab, granuloma
PO1-22-08 LONG-TERM CONTROL OF EXTRAFOVEAL IDIOPATHIC CHOROIDAL NEOVASCULARIZATION WITH SYSTEMIC STEROIDS Neri Piergiorgio (Polytechnic University of Marche-Ancona, Italy) Mariotti Cesare (Polytechnic University of Marche-Ancona, Italy), Viti Francesca (Polytechnic University of Marche-Ancona, Italy), Manoni Mara (Polytechnic University of Marche-Ancona, Italy), Giovannini Alfonso (Polytechnic University of Marche-Ancona, Italy) Introduction and objectives: Choroidal neovascularization without signs of age related macular degeneration lesions, retinal scars, or high myopia is defined as “idiopathic” (ICNV). A certain role played by inflammation has been postulated. Several techniques have been proposed for the management of ICNV, such as photodynamic therapy (PDT), laser photocoagulation, steroids associated with PDT and intravitreal anti-VEGF drugs. The goal of this study was to assess long-term efficacy and safety of systemic steroids (SS) for ICNV. Methods: The design of the study was: prospective, non-comparat ive, i n t e rventional case series. Patients re c e ived intrave n o u s methylprednisolone at the dose of 1 g daily for 3 days, followed by prednisone at the dose of 1 mg/kg daily. The primary outcome measures were: the “stability/improvement” of the best corrected visual acuity (BCVA) and the “stability/reduction” of the ICNV size. BCVA decrease or improvement was defined as a reduction or increase of 2 or more lines from the initial BCVA. ICNV size after tre atment was classified as “increased” and “ reduced” if increased or reduced of more than 200Ìm2, respectively. Results: Nine patients (9 eyes) with ICNV were considered. The median follow-up time was 18 months. At 6 months of follow-up, BCVA was better than baseline (p = 0,002); at 12 months, the difference remained significant (p=0,001). The BCVA wa s "stable/improved" in all the patients at 6 months and at 12 months of follow-up (p<0,001). At 6 and 12 months, the size of the lesion was "stable/reduced" in all cases (p<0,001). The median time for discontinuation of SS was 15 weeks (min: 11, max: 21). During the treatment, side effects were mild and transitory. Conclusions: SS were safe and effective in controlling extrafoveal ICNV. Prospective case-control trials are needed to validate the results of this study. Financial fundings: None Conflict of interest : None Key wo rd s : Idiopat h i c, ch o roidal neovascularization, Systemic Steroids
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Abstract Book PO1-22-09 AUTOLOGOUS TRANSPLANTATION OF THE RETINAL PIGMENT EPITHELIUM AND CHOROID IN THE TREATMENT OF CHOROIDAL NEOVASCULARIZATION. Siqueira Rubens C (Ophthalmology Dep a rt m e n t - C at a n d u va Medicine School-São Paulo-Brazil and CERV - Retinal and Vitreous Specialized Center of HORP - Eye Hospital of Rio Preto, São José do Rio Preto/SP-Brazil) Objectives: To evaluate the functional and anatomical outcomes of autologous translocation of peripheral choroid and retinal pigment epithelium (RPE) in patients with choroidal neovascularization of the different causes. METHODS: 4 consecutive patients with choroidal neovascularization (3 secondary to age-related macular degeneration and 1 associated with toxoplasmic retinochoroiditis) were recruited into an ethics committee approved trial with informed consent between 2006 and 2007. Patients underwent submacular removal of CNV through a single retinotomy. A full-thickness patch graft of RPE, Bruch's membrane, and choroid was harvested from the superior equatorial retina and transplanted into the subfoveal space. The graft was flattened under heavy liquid, before silicone oil exchange. Removal of silicone oil and cataract surgery were performed 3 months later. All patients underwent cataract grading, full refraction, optical coherence tomography, fundus autofluorescence, and fluorescein and indocyanine angiography. RESULTS: Preoperative visual acuity (VA) ranged from 20/800 to 20/200. Six months after surgery, VA ranged from hand movements to 20/50. Two patients without reading ability preoperatively were able to read after surgery. In all eyes, revascularization was visible on indocyanine green angiography as early as 3 weeks after surgery. Autofluorescence of the RPE was independent of revascularization of the graft and persisted throughout follow-up. All patients had unstable fixation and/or extrafoveal fixation before surgery. Two of these eyes stabilized during follow-up. Revisional surgery due to proliferative vitreoretinopathy was required in 1 eye. CONCLUSIONS: The translocation of a full-thickness graft usually results in a vascularized and functioning graft in patients with choroidal neovascularization although is associated with a high risk of complications. Longer follow-up is necessary to learn about the long-term survival and functionality of the graft. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Autologous transplantation ,retinal pigment epithelium, choroidal neovascularization
PO1-22-10 INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL NEOVASCULARIZATION COMPLICATION IN UVEITIS Céline Terrada (Pitie Salpetriere Hospital), Ghislaine Ducos (Pitie Salpetri e re Hospital), Christine Fardeau (Pitie Salpetriere Hospital), Nathalie Cassoux (Pitie Salpetriere Hospital), Phuc Lehoang (Pitie Salpetri e re Hospital), B a h ram Bodaghi (Pitie Salpetriere Hospital) Introduction and objectives: To evaluate short term safety and both anatomical and visual acuity (VA) efficacy of intravitreal bevacizumab for the treatment of choroidal neovascularization (CNV) complication in uveitis. Methods: Naive patients to treatment for juxtafoveal or subfoveal CNV secondary to uveitis were prospectively treated with 1.25 mg of intravitreal bevacizumab.
Results: Six patients (100%) had a significant decrease in central macular thickness from baseline to month 3 whereas only 4 had an improvement of VA after the injection. Two patients had received a second injection. No adverse effects were observed. Conclusions: Choroidal neovascularization in uveitis treated eyes had significant favourable short-term results concerning macular thickness and improvement in visual acuity. Financial fundings: No Conflict of interest : No Keywords: Anti-VEGF, neovascularization, uveitis
PO2-08-01 BEVACIZUMAB IN PATIENTS WHITH CHOROIDAL NEOVASCULAR MEMBRANE OF SENILE TYPE Authors: B. Bajaire, A. Leon, A.Zabaleta. Afiliation: Olsabe Ophthalmologic Center, Oftalmosanitas, San Martin Unive rsity Ophthalmology Dep a rt a m e n t , Bogota Colombia. Proposal: E va l u ate the functional and anatomical effect of Bevacizumab in patients with choroidal neovascular membrana of senile type. Materials and method: Prospective analysis of 19 eyes with choroidal neovascular membrane of senile type who received an intravitreal injection of bevacizumab 2,5 mg. The visual acuity, the anatomical result analyzing change of the macular thickness for Optical Coherent Tomography and adverse effects was evaluated to the patients from 3 to 6 months after the treatment. Results: The initial visual acuity of 19 eyes who received the medicament was minor 20/200 in 8 eyes (42.1%), 20/200 to 20/50 in 10 eyes (52.6%), the best or iqual 20/40 in 1 eye (5.2%), the Visual acuity in the 19 eyes after 3 to 6 moth after the medicament injection was minor 20/200 in 3 eyes (15.7%) in the 20/200 to 20/50 group was 14 eyes (73,6%) and 2 eyes (10.5%) had the best or iqual 20/40. The initial macular thickness varied between 1072um and 134um with a 449 average. The macular thickness after the injection varied between 365 and 110 um with a 237um average, achieving a decreased in the macular thickness close to 212um (47.3% ) average. There were not complications neither intra nor postoperative to the bevacizumab injection. Conclusions: The intravitreal Bevacizumab decreased 47.3% the retinal macular thickness and improved of the function in 26.3% eyes with choroidal neovascular membrane of senile type without any adverse effect neither intra nor postoperative to the injection. Financial fundings: none Conflict of interest: none Keywords: Neovascular, MacularThickness, Bevacizumab
PO2-08-02 THE ROLE OF CHRONIC INFLAMMATION IN AGERELATED MACULAR DEGENERATION DEVELOPMENT. Zapuskalov Igor V (Siberian State Medical University, Tomsk, Russian Federation.) Khoroshikh I Yulia (Siberian State Medical U n ive rs i t y, Tomsk, Russian Federat i o n . ) , K rivosheina I Olga (Siberian State Medical University, Tomsk, Russian Federation.), Zapuskalova B Olga (Siberian State Medical University, Tomsk, Russian Federation.) Purpose: Age-related macular degeneration (AMD) is the second
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Abstract Book leading cause of visual disability and legal blindness in individuals over 60 years of age all over the world. It has been shown that neovascularization and formation of subretinal membranes in the macular area occur due to local stimulation of various growth factors, including vascular and endothelial. However, these substances are also known to appear as a result of inflammation process. Aims of this work were: 1) to study the clinical course of AMD as a process resulted from chronic retinal inflammation; 2) to evaluate the efficacy of anti-inflammatory treatment in AMD patients; 3) to develop prevention treatment on early stages of the process before macular changes appear. Methods: 65 patients, aged 58-74 years, diagnosed with different stages of AMD were enrolled into the study. Before and after treatment all patients were followec up with indirect ophthalmoscopy extended in each patient to detailed examination of retinal periphery using scleral depressor. All patients underwent demarcating laser coagulation of peripheral retina or peripheral transscleral cryopexy followed with complex anti-inflammatory therapy. Followup period was from 3 months to 3 years. Results: In all patients, prior to the treatment, retinal periphery exam showed presence of chronic intermediate uveitis revealing multiple early infl a m m at o ry lesions along with old atrophic changes at the area of ora serrata. Visual acuity varied from light perception to 0.08. After performed laser coagulation or cryotherapy, stabilizing of both the uveitis and the macular changes was observed. Visual acuity was preserved at the same level in all patients. Conclusions: Effective treatment of intermediate uveitis, such as cryopexy, in AMD patients provides stabilization of pathological process in macula. We believe that chronic inflammation of the peripheral retina represents an important pathogenetic mechanism associated with the development of AMD. Financial fundings: no Conflict of interest: no Keywords: age-related macular degeneration, inflammation, chorioretinitis
PO2-09-01 SECONDARY DRY EYE AND ALLERGIC CONJUNCTIVITIS: INFLAMMATORY PATHOGENESIS AND COMBINED THERAPY May chuk Dmitriy Y (Moscow Feodorov Institute of Eye Microsurgery) Objectives: To research and evaluate the pathogeneses, diagnostics, therapy and prophylactics of secondary dry eye in patients with allergic conjunctivitis. Methods: The study included 120 patients with ocular allergy and two types of dry eye: tear decreased and increased production. The standard and specific dry eye tests were used in diagnostics. IgE in tear was measured. Confocal microscopy of cornea and conjunctiva, tear biochemical and protein analyses were performed. Patients received only applications with anti-inflammatory therapy, consisted of betamethazon, ophthalmoferon (combined interferon and antihistamine), antiallergic therapy with opatanol, zaditen, and different types of artificial tears. The patients were followed up from 1 to 3 years periods. Results: The inflammatory pathogenesis of the secondary dry eye was proven by confocal findings and protein tear abnormalities. Patients, receiving anti-inflammatory therapy for 1 month showed better results of dry eye tests in comparison with those, who
received only antiallergic treatment. Patients, using artificial tears, decreased the average number of acute periods during the year in 87% of the cases and their duration for up to 60%. Conclusions: The dry eye in patients with ocular allergy is secondary and could be caused by the autoimmune inflammation. It could be recommended to include anti-inflammatory therapy even in cases of light allergic condition. Tear substitute is necessary. But itâ&#x20AC;&#x2122;s type is depending on the decreased or increased tear production. Financial fundings:none Conflict of interest :none Keywords: dry eye, allergy, inflammation
PO2-09-02 EXPERIMENTAL IMMUNE-MODULATING THERAPY FOR AERO-ALLERGENS IN ALLERGIC CONJUNCTIVITIS TREATMENT. ALLEGRI PIA (LAVAGNA (GENOVA) HOSPITAL (ITALY) DEP. OF OPHTHALMOLOGY) NAPOLI GIUSEPPE (LAVAGNA HOS PITAL (ITALY) DEP. OF PAEDIATRIC ALLERGY), CATERINA MUSSO (LAVAGNA (GENOVA) HOSPITAL (ITALY) DEP. OF OPHTHALMOLOGY), LAURA CALLEGARINI (LAVAGNA HOS PITAL (ITALY) DEP. OF PAEDIATRIC ALLERGY) MURIALDO UGO (LAVAGNA (GENOVA) HOSPITAL (ITALY) DEP. OF OPHTHALMOLOGY), PERI SIMONA (SESTRI LEVANTE (GENOVA) HOSPITAL - ITALY DEP. OF PHARMACEUTIC) PURPOSE: Specific immunotherapy (ITS) proved effective in the treatment of many allergic diseases, but there are not many available clinical trials showing its efficacy in treating allergic diseases localized to the eye, like vernal and atopic kerato-conjunctivitis. Purpose of this paper is to assess the efficacy and safety of Enzyme Potentiated Desensitisation (EPD) in the treatment of severe allergic conjunctivitis of young patients, poorly controlled by classic pharmacotherapy. This particular IT consists of a sub-dermal injection mix made up of allergen extracts at very low doses and of an enzyme called betaglucuronidase. MATERIALS AND METHODS: 53 patients were included in the study, aged between 7 and 20 (mean age 11.5 + 3.2), 37 males and 16 females, affected by allergic conjunctivitis: 18 patients were suffering from seasonal allergic RhinoConjunctivitis, 23 from Vernal Kerato Conjunctivitis, 12 from Atopic Ke rato-Conjunctivitis. Classification and diagnosis of the ocular disease were made by means of careful history and ophthalmological examination (on the basis of IOIS allergic conjunctivitis classification) and allergological routinary study (blood PRIST and RAST). We added specific ocular tests like conjunctival provocation test, tear ECP and tryptase dosage, tear specific (for Dermatophagoides, cat, cypress, olive tree, pellitory, and gramineae) IgE dosage. We followed the McEwen method of EPD administration based on 3 subsequent sub-dermal injections in the first year (about each 4 months), 2 in the second and third year (each 6 months), Patients were examined before starting the trial, at each EPD dose, and 6 and 12 months after the last EPD injection. According to the protocol, the day after the injection the patients had to follow a support therapy based on different age-dependent dosages of Zinc sulphate, Folic acid, Vitamin D. Mean follow-up was 38 + 4 months. The reduction or interruption of local and/or systemic drugs and ophthalmological clinical examination improvement were considered a success
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Abstract Book
Financial fundings: NO FINANCIAL FUNDING Conflict of interest : NO CONFLICTS OF INTEREST Keywords: ALLERGIC CONJUNCTIVITIS, IMMUNE-MODULATING THERAPY, ENZYME POTENTIATED DERIVATIVE (epd)
PO2-09-03 SUPRATARSAL INJECTION OF TRIAMCINOLONE ACETONIDE IN REFRAC TO RY ALLERGIC KERATO C O NJUNCTIVITIS. Zaouali Sonia (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Mnasri Heni (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Trigui Manal (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Ammari Wafa (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Ben Yahia Salim (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia) Khairallah Moncef (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia) Introduction and objectives: To study the efficacy and safety of supratarsal injection of triamcinolone acetonide in patients with severe allergic keratoconjunctivitis. Methods: Fourteen patients (28 eyes) with severe allergic keratoconjunctivitis were included in this retrospective study. Six patients had vernal keratoconjunctivitis and 8 had atopic keratoconjuncivitis. All patients underwent a bilateral supratarsal injection of 20 mg triamcinolone acetonide. Results: All patients showed a significant symptomatic improvement and partial resolution of clinical features of keratoconjunctivitis within the first two weeks. Corneal complications related to keratoconjunctivitis disappeared in all patients. None patient experienced ocular hypertension or cataract. An aggravation of ptosis was observed seen in 2 patients. Relapse of disease was noted in 11 patients after a mean follow-up of 9 months. Conclusions: Supratarsal injection of triamcinolone acetonide may be effective and safe in patients with severe keratoconjunctivits to temporary relieve severe inflammation associated with allergic keratoconjunctivitis. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Keratoconjunctivitis, Triamcinolone, Allergy
PO2-09-04 COMPARATIVE STUDY OF COMMERCIALLY AVA I LABLE ANTIHISTAMINIC DROPS IN AN ANIMAL MODEL OF EARLY PHASE ALLERGIC CONJUNCTIVITIS Montero Javier A (Vissum, Alicante Institute of Ophthalmology), Sanchis M Eugenia (Pio del Rio Hortega University Hospital, Valladolid), Ruiz-Moreno M Jose (Vissum, Alicante Institute of Ophthalmology) Objective: To compare the relative efficacy of topical ocular antihistaminic drops with balanced saline solution (BSS) and benzalkonium chloride (BC) in the early phase of allergic conjunctivitis in animal model. Methods: 80 male guinea pigs were sensitized with intraperitoneal egg albumin (EA) and alum. Eighteen days after sensitization the animals were topically challenged by conjunctival instillation of EA. The animals were treated 15 minutes before and 15 minutes after challenge with commercially available drugs. Ketotifen with and without preservative, olopatadine, azelastine, spaglumic acid
and emedastine were tested. BSS and BC drops were tested as controls. Different drops were tested in the right and the left eye of each animal to avoid interanimal differences in allergic reactivity. The allergic reaction was measured by intravenous Evans blue extravasation (EBE) under general anaesthesia. Results: Two animals could not be used for evaluation. EBE was highest in the eyes treated by azelastine, olopatadine and preservative free ketotifen, and lowest in the eyes treated by spaglumic acid. However, when the results of the right and left eyes of each animal were considered EBE was higher in the eyes treated by BSS and BC and lowest in the eyes treated by spaglumic acid and emedastine. Conclusion: Spaglumic acid and emedastine seem to be the most useful drugs to reduce EBE in an animal model of early phase allergic conjunctivitis. Financial fundings: Junta de Castilla y Leon (SACYL) Conflict of interest: None Key wo rd s : Animal model, a l l e rgic conjunctivitis, commercial drops
PO2-10-01 CLINICAL PROFILE AND OUTCOME IN BURKHOLDERIA CEPACIA ENDOPHTHALMITIS Pathengay Avinash (Visakhapatnam L V Prasad Eye Institute), Joseph Joveeta (L V Prasad Eye Institute), Sachdeva Virender (L V Prasad Eye Institute), Das Taraprasad (Bhubenswar LV Prasad eye institue), Sharma Savitri (Bhubenswar LV Prasad eye institue) INTRODUCTION: To study the clinical presentation, antibiotic sensitivities and visual acuity outcomes of Burkholderia cepcia endophthalmitis. Study Design: Retrospective , non-comparative, interventional case series Methods: Medical records of all patients treated for Burkholderia Cepacia endophthalmitis seen at LV Prasad Eye institute , India between January 2003 and December 2005 were reviwed . Results: Burkholderia cepacia species was isolated in 11 cases ( 2.5 % ) of the 444 cases of culture proven endophthalmitis . Endophthalmitis was acute onset in nine and delayed onset in two cases . Endophthalmitis followed cataract surgery ( 9 ) , penetrating keratoplasty ( 1 ) and trauma ( 1 ) . Initial procedures included viteous biopsy ( 2 cases ) or pars plana vitectomy ( 9 cases ) along with injection intravitreal antibiotics . Multidrug resistance was noted in all cases. Isolates were found to be most susceptible to Ceftazidime and ciprofloxacin ( 76. 7 % ) . Initial visual acuity was light perception or better in 10 cases ( 90.9 % ) . 9 patients were followed up for a mean duration of 4.5 months (1-9 months ) and were lost to follow ? up in 2. Final visual acuity was 20 / 200 or better in 5 /11 eyes ( 45. 55 % ) . Epiretinal membrane ( 1 ) , Retinal detachment ( 2 ) and CNVM ( 1 ) , accounted for poor visual outcome . Conclusion: Burkholderia cepacia may cause acute or delayed onset endophthalmitis , associated with multidrug resistance and despite treatment with intravitreal antibiotics , may produce chronic inflammation and poor visual outcomes . Financial fundings: nil Conflict of interest : nil Keywords: Burkholderia cepacia , multidrug resistance , endophthalmitis
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Abstract Book PO2-10-02 IS INTRAVITREAL PIPERACILLIN/TAZOBACTAM USEFUL IN THE MANAGEMENT OF MULTIDRUG RESISTANT BACTERIAL ENDOPHTHALMITIS Pathengay Avinash (VISAKHAPATNAM L V Prasad eye institue), M athai Annie (L V Prasad eye institute), S h a rma Sav i t ri ( Bhubaneswar LV Prasad eye institute) Purpose: To describe the usefulness of intrav i t re a l piperacillin/tazobactam in the management of multidrug resistant bacterial endophthalmitis. Methods: This case series include 3 patients (1 post traumatic and 2 post penetrating keratoplasty surgery) culture proven bacterial endophthalmitis. During the initial surgical procedure intavitreal vancomycin and amikacin or ceftazidime were administered. On the third post operative day 225 micrograms/0.1 ml of piperacillin/tazobactam was injected after noting clinical deterioration and the vitreous isolates (Enterobacter spp and Psuedomonas aeuroginosa) were resistant to the initially administered and other routine intravitreal antibiotics. Results: There was complete resolution of inflammation following intravitreal pipeacillin/tazobactam with improvement in visual acuity. Conclusion: Intravitreal pipeacillin/tazobactam could be a treatment option in the cases of multidrug resistant bacterial endophthalmitis. Financial fundings: nil Conflict of interest: nil Key wo rd s : piperacillin/tazobactam,mu l t i d rug resistance,endophthalmitis
PO2-10-03 CANDIDA PARAPSILOSIS ENDOPHTHALMITIS IN A PATIENT INFECTED WITH HIV Vellaniparambil Raly (Leighton Hospital ), El Khashab Tarek (Leighton Hospital), G a n ga ram Ve n k at (Leighton Hospital), Neugebauer Mark (Leighton Hospital Case report: We present a 37 year old patient infected with HIV since 8 years and had pan uveitis.He underwent vitreous aspiration from the left eye along with injection of intravitreal antibiotics (ceftazidime and vancomycin), the vitreous aspirate was positive for candida parapsilosis on doing the polymerase chain reaction. He was treated with oral flucanazole. The inflammation in the left eye improved and after 3 weeks the visual acuity was 6/6 in the left eye with complete disappearance of vitreous infiltrates and retinal lesions . Discussion: Candida parapsilosis has been isolated from soil, water and plants, it can also be found as part of the normal flora of human skin. Candida parapsilosis first reported in 1928 was not considered a pathogen till it was described in a case of endocarditis in 1940. In immunocompromised patients it has been known to cause fungaemia, endocarditis, septic arthritis and peritonitis. Endophthalmitis caused by candida parapsilosis is not common and was first reported in 1973 following cataract surgery. Outbreaks of postoperat ive candida parapsilosis endophthalmitis have been reported due to contamination of irrigating fluid during manufacture. Oral fluconazole has good intraocular penetration and has been successful in treatment of candida parapsilosis. Fluconazole is also without the serious side effects of amphotericin B. Other ocular infections reported are corneal ulceration in a patient receiving
steroid therapy and interface keratitis after laser in situ keratomileusis. Financial fundings: (None.) Conflict of interest: (None.) Keywords: candida parapsilosis, endophthalmitis, hiv
PO2-10-04 PARS PLANA VITRECTOMY AND SILICONE OIL TAMPONADE FOR ACUTE ENDOPHTHALMITIS TREATMENT Siqueira Rubens C (Catanduva Medicine School-São Paulo-Brazil and CERV - Retinal and Vitreous Specialized Center of HORP Eye Hospital of Rio Preto, São José do Rio Preto/SP-Brazil) Gil D Aline (CERV - Retinal and Vitreous Specialized Center of HORP Eye Hospital of Rio Preto, São José do Rio Preto/SP-Brazil), Minari Miriam (CERV - Retinal and Vitreous Specialized Center of HORP - Eye Hospital of Rio Preto, São José do Rio Preto/SPBrazil) Canamary Fabio (CERV - Retinal and Vitreous Specialized Center of HORP - Eye Hospital of Rio Preto, São José do Rio Pre t o / S P - B razil) Jorge Rodri go (Retina and Vitreous Section. Department of Ophthalmology. School of Medicine of Ribeirão Preto. University of São Paulo. Brazil ) Introduction and Objectives: To evaluate the outcomes of pars plana vitrectomy (PPV) and silicone oil injection for the treatment of infectious endophthalmitis. Methods: 35 cases of endophthalmitis secondary to phacoemulsification (20 patients), trabeculectomy (8 patients), perforating trauma (2 patients), trauma (2 patients) , corneal transplantation (1 patient), vitrectomy (1 patient) and corneal ulceration (1 patient) we re re t rospective ly studied. Patients we re sep a rated in two groups: Group 1(n=24): intravitreal antibiotic injection (IVAB), associated with topical and oral antibiotics; group 2 (n=11): vitrectomy with IVAB and silicone oil. The follow-up ranged from 1 to 48 months (mean of 16 months). Endophthalmitis diagnosis was based on clinical findings and confirmed by culture of vitreous samples. Results: From 24 patients in group 1, 11 patients (45,83%), had infection control just with intravitreal antibiotic injections; 13 patients (54,15%) regressed to uncontrolled endophthalmitis, in which two patients (8,33%) were submitted to evisceration and one patient (4,16%) had corneal melting. The remaining 10 patients (41,66%) with uncontrolled endophthalmitis were submitted to pars plana vitrectomy and silicone oil tamponade. Six patients (25%) from Group I had retinal detachment during the first month of follow-up and also required pars plana vitrectomy and silicone oil. In group 2 patients (n=11), all of them had controlled infection at the first procedure and did not need further surgery, except for removal of silicone oil three months later. In one case (9,09%), a severe PVR induced loss of vision (NLP). Conclusions: These results suggest that silicone oil tamponade might be beneficial in the treatment strategy of infectious endophthalmitis. Financial fundings: (None.) Conflict of interest: (None.) Keywords: endophthalmitis,vitrectomy,silicone oil
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Abstract Book PO2-10-05 LINEZOLID FOR TREATING BACTERIAL ENDOPHTHALMITIS Udaondo Patricia (Hospital General Valencia) Diaz-Llopis Manuel (Hospital General Valencia), Garcia-Delpech Salvador (Hospital General Valencia), Salom David (Hospital General Valencia), Palomares Paula (Hospital General Valencia), M o ratal Peiró Baltasar (Hospital General Castellon) Introduction and Purpose: To describe the good evolution of a bacterial endophthalmitis resistant to vancomycin after initiating a treatment based on topical and oral linezolid. Methods: We report a case of bacterial endophthalmitis four months after penetrating keratoplasty in an immunocompetent 68 year-old-man. Results: The corneal infection failed to respond to intravitreal injection of vancomycin and amikacin, systemic moxifloxacin and topical vancomycin and tobramycin. Aqueous humour cultures we re positive to Streptococcus ep i d e rmidis resistant to va ncomycin. Then we decided to initiate a treatment with topical and oral linezolid in substitution to vancomycin and moxifloxacin respectively. The patient experienced rapid reduction of intraocular inflammation and pain, as well as resolution of the infection without additional intervention. No side effects were observed. (There are photographs before and after treatment) Conclusions: Linezolid which exhibits excellent tissue penetration and gets significant concentrations in aqueous and vitre o u s humours after systemic administration, is an effective and save treatment of endophthalmitis; it can also be given for an external use (eyedrops) without additional toxicity. Financial fundings: No financial interest Conflict of interest: No conflict of interest Keywords: Linezolid, endophthalmitis, vancomycin, resistance.
PO2-10-06 BACTERIAL CONTA M I NATION OF THE ANTERIOR CHAMBER AFTER SUTURE CLOSURE IN CATARACT SURGERY Daneshmand Eslami Amir Reza (Department of Ophthalmology , National Medical Academy of Postgraduate Education of Ukraine), Daneshmand Eslami Amir Reza (Department of Ophthalmology , National Medical Academy of Postgraduate Education of Ukraine) Introduction and objectives: To estimate a bacterial contamination of the anterior chamber after suture closure in the end of cataract surgery. Method: 30 patients (30 eyes) having cataract extraction operation were included in the study. All the patients were divided into 5 groups, 6 cases constitute each group. Preoperatively the all patients 0, 5% levofloxacin(LVFX), 0, 3% Lomefloxacin(LOFX), 0, 3% ofloxacin(OFX), 0.3% ciprofloxacin(CPFX) or tobrex were administered. Before and postoperatively samples from the eyelid margins, conjunctiva were obtained. At the end the operation after suture closure anterior chamber fluid (ACF) (0.25ml) for identification and ADDST were obtained. Results: Only 15 eyes – 50% have no positive colony forming (PCF) from eyelid margin and conjunctiva. PCF of ACF 9%: from 2 eyes 6% (MRCNS- S: LVFX, OFX, CPFX and from 1 eye 3% corinebacterium xerosis(CX). Preoperatively PCF: from eyelid margin- 3% CX, 3% MRCNS- S: LVFX, OFX, CPFX and gatifloxacin . 3% streptococcus viridans. PCF: from conjunctiva- 6.6% CX and 6.6% MRCNS- R: LVFX, OFX, CPFX and gatifloxacin.
Postoperatively PCF: from eyelid margin- 0%. Postoperatively PCF: from conjunctiva-3% streptococcus hemolytic, 3% MRCNSIM: LVFX, OFX, and gatifloxacin,R: CPFX. 3% MSCNS- S: LVFX, OFX, and gatifloxacin, R: CPFX. Conclusion: There has been no connection between bacterial contamination of ACF and PCF of lid margins and conjunctiva. Bacterial contamination of ACF inevitable in cataract extraction surgery. Financial fundings: My research is bing done on the basis of Department of Ophthalmology , National Medical Academy of Postgraduate Education of Ukraine. Conflict of interest : My potential conflict of interest is on the basis of dissertation " prevention of post-operative endophthalmitis". Keywords: MRCNS, MSCNS, colony forming
PO2-10-07 MANAGEMENT OF SERIAL ENDOPHTHALMITIS Pajot Olivier (CHU A n ge rs ) , Gautier David (CHU Ange rs ) , Lemarié Carole (CHU Angers), Ebran Jean-Marc (CHU Angers), Jallet Ghislaine (CHU Angers), Cochereau Isabelle (CHU Angers) Purpose: To describe the management of a series of endophthalmi tis. Methods: One month after the moving of the hospitalisation department and the operating room, six patients presented an endophthalmitis during a 4 months period. The series was declared at the CLIN (nosocomial infection committee), at the DRASS (medical and social regional department) and a recording in the national endophthamitis file were done. The whole surgery procedure was checked by 3 CLIN evaluations. An inquire case-witness was finally realised. Results: The fi rst eva l u ation recommended a time reduction between the first skin disinfection and the incision. The second and third evaluation and the regional CLIN visit didn't show any dysfunction. The inquire case-witness only showed more anticoagulant treatment in the endophthalmitis group. After moving of the 3 adjacent orthopaedic operating rooms none increased incidence of nosocomial infections was observed. Discussion: Even if no etiology was discovered, such endophthalmitis serie is probably related to organization and structural modifications in a new building. It was difficult to determine the reasons in spite of hygienist deep investigations. Anticoagulant drugs are probably indirectly involved as a co morbidity factor. Such endophthalmitis series must be managed in cooperation with hygienists by crossing informations to find etiologies. Conclusion: When a serial endophthalmitis occurs, the checking of the whole surgical procedure is important in collaboration with hygienists. The stress of the staff requires a special attention in front of this frightening situation. Financial fundings: (None.) Conflict of interest: (None.) Keywords: ENDOPHTHALMITIS, SERIES, MANAGEMENT
PO2-10-08 RISK FACTORS FOR ENDOGENOUS KLEBSIELLA ENDOPHTHALMITIS IN PATIENTS WITH KLEBSIELLA BACTERAEMIA – A CASE -CONTROL STUDY Sng Chelvin C. A. (National University Hospital, Singapore) Jap Aliza (Changi General Hospital, Singapore), Chan Yiong Huak
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Abstract Book (National University of Singapore) Chee Soon-Phaik (Singapore National Eye Centre, Singapore) Introduction and objectives: Endogenous Klebsiella endophthalmitis is a potentially sight-threatening condition. Familiarity with the clinical setting in which it is likely to occur will hasten diagnosis and may improve outcome. This study aims to identify risk fa c t o rs for Klebsiella endophthalmitis in patients with Klebsiella sepsis. Methods: This is a retrospective case control study. The study population consisted of all patients with positive blood cultures for Klebsiella, admitted to Changi General Hospital (Singapore) from August 2004 to July 2005. The cases were patients who developed Klebsiella endophthalmitis and the controls were those who did not. The potential risk factors analysed included age, sex, race, the total white count at pre s e n t ation; the maximum temperat u re response; co-morbid pathologies; presence of severe infection; site of primary infection; antibiotic sensitivity of the bacteria strain; and the systemic antibiotics treatment regime. Results: One hundred and thirty three consecutive patients with Klebsiella bacteraemia proven by blood culture were included in this study, 15 of whom died within 3 days of presenting with sepsis. The duration of medical follow-up ranged from 3 hours to 1045 days (mean=416 days). 5 patients (3.8%) developed endophthalmitis. Klebsiella endophthalmitis was significantly associated with liver abscesses as the primary site of infection (p<0.001); and disseminated intravascular coagulation (DIVC) (p=0.010) on both univariate and multivariate analysis. The association between endophthalmitis and a lower total white cell count at presentation (p=0.007) was significant in univariate analysis and close to significance in multivariate analysis (p=0.071). Diabetes mellitus and other co-morbid pathologies, race and the maximum temperature response were not risk factors for the occurrence of endopthalmitis. Conclusions: Liver abscess and DIVC are risk factors for endogenous endophthalmitis in patients with Klebsiella sepsis. Financial fundings: nil Conflict of interest : nil Keywords: Endophthalmitis, Klebsiella, Case-control
tiologists advice and confirmed the diagnosis of Candida albicans. Discussion : Candidiasis is probably due to Subutex inoculation. The agentâ&#x20AC;&#x2122;s identification is absolutely necessary for the best suitable treatment. Conclusion: Diagnosis of Candida chorioretinitis in a drug-addict patient must be evoked in case of visual impairment. It may be sometimes necessary to perform a vitreous biopsy to isolate the pathogen in atypical infectious cases.
PO2-10-10 IN VITRO ANTIBACTERIAL ACTIVITY OF ENDOTAMPONADING GASES Montero Javier A (Vissum, Alicante Institute of Ophthalmology), Ruiz-Moreno M Jose (Vissum, Alicante Institute of O p h t h a l m o l ogy ) , S a n chis M Eugenia (Pio del Rio Hortega University Hospital, Valladolid) Introduction and objectives: Gases used for intravitreal injection seem to have no chemical or pharmacologic toxicity to ocular tissues, and their beneficial or harmful effects seem to be related mainly to their physical effects. However, the bacteriostatic or bactericidal effects of SF6 and C3F8 have not been adequately investigated. To investigate the in vitro antibacterial and antifungal activity of endotamponading gases. Methods: Staphylococcus aureus, Staphylococcus epidermidis and Candida albicans were cultured on specific solid media and blood agar plates in sulfur hexafluoride (SF6) and perfluoropropane (C3F8) atmospheres, and in aerobic and anaerobic atmospheres as controls. Differences in germ growth were considered. Results: Growth patterns for cultures under SF6 and C3F8 atmospheres were similar to those of anaerobic conditions. No inhibition of germ growth by endotamponading gases was observed. Conclusions: The in vitro effect of SF6 and C3F8 on cultured strains seems to be related to oxygen deprivation. SF6 and C3F8 do not seem to have in vitro antibacterial activity on the most frequent intraocular pathogen germs. Financial fundings: None Conflict of interest: None Keywords: Endotamponading gas, culture, in vitro
PO2-10-09 TWO STOREYED SPONDYLODISCITIS ASSOCIATED WITH CANDIDA CHORIORETINITIS G. Baglin, P. Betermiez, A. Berthout, JL. Schmit, S. Milazzo (Amiens University) Introduction: Ocular candidiasis is observed in two principal populations: drug-addict individuals and patients with intravenous catheters. The inoculation of yeast occurred after contamination of the solution injected or the material by the Candida from the oral flora. Case report: A 29 year-old Caucasian intravenous drug-addict male, currently treated by Subutex presented rachialgias evolving for a few months on an inflammatory rhythm. During hospitalization, an infectious spondylodiscitis involving T8- T9 - T10 without neurological signs was diagnosed. No pathogenic agent was found on haemocultures and vertebral disc puncture. Then an important left visual decrease appeared limited to hand motions. Posterior manifestations appeared as a large necrotic retinal area associated with vitritis. Diagnostic vitrectomy was performed based on infec-
PO2-10-11 Post-traumatic scedosporium apiospermum endophthalmitis treated with intravitreal and general voriconazole. NOCHEZ Yannick (CHU de Tours - Service d'ophtalmologie), ARSENE Sophie (CHU de Tours - Service d'ophtalmologie), LE GUELLEC Chantal (CHU de Tours - Service de pharmacologie), MORANGE Virginie (CHU de Tours - Service de bactĂŠriologie), PADOIN Christophe (CH Avicenne), PISELLA Pierre-Jean (CHU de Tours - Service d'ophtalmologie) Introduction and Objectives: Due to its primary multi-drug resistance and its systemic dissemination, treatment of an infection by Scedosporium is difficult with traditional fungicides. We report a pharmacokinetic study of combined systemic and intravitreal voriconazole treatment of a post traumatic Scedosporium apiospermum endophthalmitis. Methods: A 29-year-old man developed endophthalmitis after being struck by a swimming pool pump. Despite a three weeks
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Abstract Book antibiotherapy, his visual acuity remained perception of light and vitreous inflammation increased. A vitreous sample taken from the left eye during the vitrectomy grew a filamentous fungus identified as Scedosporium apiospermum, which was resistant to amphotericin B and sensitive to voriconazole (CMI, 0,008 mg/L). Results: Oral voriconazole at 200 mg twice daily did not bring the infection under control owing to low plasma and intravitreal concentrations. After one week of intravenous voriconazole at 4 mg/kg/day serum concentration of voriconazole was also very low: 0.2 μg/ml 12 hours after infusion (instead of 0.8 – 2.2 μg/ml). Before steady-state plasma voriconazole concentrations reached an efficacy level, intravitreal injections of 64 ug/0,1 ml of voriconazole were initiated twice weekly for three weeks. An improvement of the vitreous and retina was noted. Administration of higher intravenous voriconazole doses ( 6 mg/kg b.i.d. ) for 6 weeks was needed to achieve an antifungal effect without systemic dissemination. Even though antifungal therapy led to i m p rovement in the intraocular inflammation, the result was a poor visual outcome because of a retinal detachment and residual hypotony. Conclusions: Scedosporium apiospermum endophthalmitis can be treated safely and effectively without systemic dissemination with intravenous voriconazole combined with a surgical excision by pars plana vitrectomy. Intravitreal voriconazole injections could also be an effective therapy, before the steady state of a systemic treatment is reached. Financial fundings: No financial fundings. Conflict of interest: No potential conflicts of interest. Keywords: endophthalmitis, voriconazole, pharmacokinetics.
PO2-11-01 MACULAR INVOLVEMENT IN RECURRENT TXOPLASMOSIS Muccioli Cristina (Federal University of Sao Paulo,Brazil), Amaro H Miguel (Federal University of Sao Paulo,Brazil), Abreu T Mariza (Federal University of Sao Paulo) Introduction and Objective: to relate the incidence of the macular involvement in a case series of recurrent Toxoplasmosis Methods: We analized 23 eyes of 23 patients with recurrent Toxoplasmosis through Fluorescein and Indocyanine green Angiography.We used Friedman and Knox classification of the recurrent retinitis. Results: 30.4% of the cases presented macular involvement.Large destructive recurrent retinitis was the most commom form.Remote Hypofluorescent dots on ICG was found in two cases Conclusions: R e c u rrence is a commom event in ocular Toxoplasmosis.Macular involvement was diagnosed in 30.4% of the cases. Remote Hypofluorescent dots on ICG was an underscribed finding in macula involvement in Ocular Toxoplasmosis. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Toxoplasmosis,Uveitis,Inflammation
PO2-11-02 REMOTE HYPOFLUORESCENT DOTS ON ICG IN RECURRENT TOXOPLASMOSIS Muccioli Cristina (Federal University of Sao Paulo), Amaro H Miguel (Federal University of Sao Paulo,Brazil), Abreu T Mariza (Federal University of Sao Paulo) Belfort Jr Rubens (Federal University of Sao Paulo)
Introduction and Objective: to describe the Indocyanine findings in a case series of Recurrent Toxoplasmosis Methods: This is a institutional prospective study of 23 eyes of the 23 patients with ocular recurrent toxoplasmosis analized by fluorescein angiography and Indocyanine Green angiography(ICG). Results: Our findings of the ICG were: a)Hypofluorescence in the active recurrent lesions in all the cases b)Multiple hypofluorescent dots surrounding the active lesion in 69.56% of the cases c)Multiple Hypofluorescent dots (that we call Remote dots) in normal area in the fundoscopy and fluorescein angiography in 26.08% of the cases and d)Hyperfluorescent dots in the region of the active lesions in 8.69% of the cases. Conclusions: Remote Hypofluorescent Dots an underscribed finding on ICG in recurrent Toxoplasmosis was the most important finding in our case series of Toxoplasmosis. Further studies will be necessary to elucidate the significance of this,if these lesions are silent foci of the infection or remote inflammatory cells collection. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Toxoplasmosis,Uveitis,Inflammation
PO2-11-03 OCULAR MASQUERADE SYNDROME DUE INTRAOCULAR LYMPHOMA, TWO FORMS OF RPE INVOLVEMENT Muccioli Cristina (Federal University of Sao Paulo,Brazil) Amaro H Miguel (Federal University of Sao Paulo,Brazil) Abreu T Mariza (Federal University of Sao Paulo, Brazil) Introduction and objectives: To show the ocular findings from two patients with masquerade syndrome due intraocular Large cells non-Hodgkin's Lymphoma from a case series of non-Hodgking's lymphoma patients. Methods: We evaluated two patients with chronic uveitis and ocular findings antedating the diagnosis of large cells non-Hodgkin's lymphoma. The patients were include in a case series of 15 patients with nonHodgkin's Lymphoma to evaluate the ocular involvement. Po s t e ri o rly,one presented systemic fo rm of large cells nonHodgkin's lymphoma and the other primary central nervous system lymphoma. Resuts: The first patient presented chronic uveitis of indetermined cause and yellowish-white flecks in the Retina Pigment Epithelium and posteriorly developed Large-cells systemic non-Hodgkin's lymphoma. The second patient presented chronic uveitis of indetermined cause and multiple solid Retina pigment ephitelium detachments preceding a large-cells central nervous system non-Hodgkin's lymphoma. Conclusions: two forms of retina pigment epithelium involvement were found in two large-cells non-Hodgkin's lymphoma patients. Yellowish-white flecks in the retina pigment epithelium was found in a systemic non-Hodgkin'g lymphoma patient that died of central nervous system involvement and multiple solid retina pigment epithelium detachments preceding the central nervous system nonHodgking lymphoma, in the other patient. The first case is a example of that Gass and others has observed that there is some overlap in two forms of large-cells non-Hodgkin's lymphoma. Financial fundings: (None.) Conflict of interest: (None.)
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Abstract Book Keywords: Uveitis,Lymphoma,Masquerade syndrome
PO2-11-04 IN VIVO CONFOCAL MICROSCOPY OF KERATIC PRECIPITATES IN FUCHS’ HETEROCHROMIC CYCLITIS (FHC) LABETOULLE Marc (Hopital de Bicetre, South-Paris University), LABBE Antoine (Hopital des Quinze-Vingts, Pa ri s ) , DUPAS Bénédicte (Hopital des Quinze-Vingts, Paris), DE MONCHY Ivan (Hopital de Bicetre, South-Pa ris University), OFFRET Herv é (Hopital de Bicetre, South-Pa ris Unive rs i t y ) , BAUDOUIN Christophe (Hopital des Quinze-Vingts, Paris) Objectives: To study the pattern of keratic precipitates (KPs) in Fuchs’ Heterochromic Cyclitis (FHC) using in vivo confocal microscopy. Methods: KPs of 11 consecutive patients (average age: 44+/-10 years), addressed for suspicion of FHC, were examined using the HRT II Rostock Cornea module, between May 2006 and March 2007. The iridocyclitis was unilateral in all patients. The diagnosis of FHC was suspected on the basis of clinical patterns of the ocular inflammation and the lack of evidence for another infectious or immunological cause. Eight patients had already been operated for cataract, one for glaucoma, and 3 patients were currently treated for glaucoma. At the time of in vivo confocal microscopy, the FHC was in a stable period (no recent increase of inflammation). Results: The HRT II Rostock Cornea allowed obtaining very precise images of KPs, which reproducibly had a star pattern with bridges connecting KPs between each others. Conclusions: FHC is a classic cause of unilateral and hypertonic uveitis. If the clinical pattern is often very suggestive, certain cases are difficult to differentiate from viral uveitis, notably herpetic uveitis. The very reproducible pattern of KPs in FHC using in vivo confocal microscopy should be helpful in such cases. Financial fundings: None Conflict of interest: None Keywords: Fuchs, Confocal, Imaging
PO2-11-05 THE VALUE OF FFA FOR DIAGNOSIS AND TREATMENT OF THE POSTERIOR UVEITIS Hong LU (Dept of Ophthalmology, Beijing Chaoyang Hospital, Capital of Medical Sciences) Objective: To discuss the value of FFA for diagnosis and treatment of the posterior uveitis. Methods: 36 cases (67 eyes) suffered with posterior uveitis were checked by slit lamp, three-side mirror, fudus scope,panretinoscope and etiological examination. Before treatment, fudus photograph and FFA were performed in all patients. Results: VKH 12 cases, 23eyes, 5 cases incorporated with diabetes. ARN 2 cases, 3 eyes. CMV 2 cases, 4 eyes. Eale ? s disease 8 cases, 16 eyes. Beh?et disease 12 cases, 22 eyes. Conclusions: FFA is an essential method to diagnose fundus diseases. FFA can discover some pathological processes which are difficult to find in clinic, and has high value to diagnose some special uveitis. FFA is helpful to analyze the level of disease, evaluate the effect of treatment, judge the moment of operation, guide the following observation and estimate the prognosis.
Financial fundings: (None.) Conflict of interest: (None.) Keywords: computer image processing system, fundus fluorescence angiography ,posterior uveitis
PO2-11-06 OCT IN ACUTE ANTERIOR UVEITIS PAZ MORENO-ARRONES JAVIER (UNIVERSITY HOSPITAL PRINCIPE DE ASTURIAS), TEUS GUEZALA A MIGUEL (UNI VERSITY HOSPITAL PRINCIPE DE ASTURIAS), GORRONO ECHEVARRIA B MARINA Introduction and objetives: To evaluate the macular thickening, the state of the optic disc and retinal nerve fibers layer (RFNL) in patients with an actual episode of acute anterior uvetis (AAU) by optical coherence tomography (OCT), and compare them with a control group. Methods: In this prospective, cross-sectional, observational and controlled study we recruited 23 consecutive eyes of 20 patients with an actual episode of AAU, age and sex-matched with 40 healthy eyes of 20 volunteers. The age ranged between 8 and 78 years old, and all were evaluated by the scans ?fast macular thickness?, ?fast optic disc? and ?fast RFNL thickness? by OCT. The patients were evaluated twice in the period of 1 month in order to make an average between the two measurements by OCT. Result: we found a statistically significant increase in macular volume in AAU eyes compared with control eyes. Total macular volume in uveitic eyes was 7,3 +/- 0,6 mm? and in healthy eyes was 7,01 +/- 0,3 mm? (p<0,001). Indeed, we found a statistically significant increase in the superior RFNL thickness as compared with controls. The Smax/Imax measurement was 1,05 +/- 0,1 (mean +/standard deviation) in pathological eyes and in healthy eyes it was 0,97 +/- 0,1 (p<0,02). Conclusions: We found by OCT that patients suffering an AAU had an increase in macular volume and an increase in the superior RFNL thickness versus control eyes in the acute episode. Financial fundings: no Conflict of interest: We found by OCT that patients suffering an AAU had an increase in macular volume and an increase in the superior RFNL thickness versus control eyes in the acute episode. Keywords: MACULAR EDEMA, UVEITIS, OCT
PO2-11-07 IN-VIVO CONFOCAL MICROSCOPY AS A NEW DIAGNOSTIC TOOL IN FUCHS UVEITIS SYNDROME Mackensen Friederike (Interdisciplinary Uveitis Center University of Heidelberg, Germany) Dali Nazife (Interdisciplinary Uveitis Center University of Heidelberg, Germany), Setiobudi Cecilia (Interdisciplinary Uveitis Center Unive rsity of Heidelberg, Germany), Rosenbaum T James (Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA), Lim L Lyndell (Casey Eye Institute, Oregon Health & Science Unive rs i t y, Portland, OR, USA), Becker D Matthias (Interdisciplinary Uveitis Center, University of Heidelberg, Germany) Introduction and Objectives: Fuchs Uveitis Syndrome (FUS) is a diagnosis made by clinical signs, the main ones being heterochromy or diffuse iris defects. When the latter two signs are not present, diagnosis is difficult to state. The Heidelberg Confocal Laser microscope with the Rostock
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Abstract Book Cornea Module attachment (RCM) allows high resolution imaging of cellular details at the corneal level, such as keratic precipitates (KP). Here we describe a distinctive KP morphology that appears to be specific for FUS. Methods: Patients diagnosed with definite or probable FUS (n = 37) were examined clinically and with the HRT RCM from January 2006 to date. Pictures were graded using strict criteria and were compared to a cohort of other subjects with different forms of uveitis (n = 75). Diagnostic certainty for FUS was determined with clinical criteria (definite if heterochromia or transillumination defects were present or probable if absent), and correlated to the HRT RCM findings. Results: 69% of the FUS patients were found to have stellate KP on the HRT RCM, but only 23% showed stellate KP in slitlamp exam on the same day. Four patients did not show any KP on HRT or slitlamp Exam. Of the patients with a definite diagnosis of FUS and KP on HRT at the time of examination (n=22), 71% showed stellate KP with the HRT RCM. The patients with a probable diagnosis, (n=12), showed stellate KP with the HRT in 67%. In contrast, stellate KP with HRT were found in only 10 subjects (13%) within the group of other Uveitis subsets. Conclusion: Our findings suggest that the HRT RCM may have a role in the early diagnosis of FUS even when heterochromia or iris transillumination defects are not present. The HRT seems to be more sensitive to detect stellate appearing KP than slitlamp exam. Financial fundings: Friedrich Fischer Award of the faculty of medicine, University of Heidelberg Conflict of interest: None Keywords: Uveitis, imaging, Fuchs
PO2-11-08 OPTICAL COHERENCE TOMOGRAPHY(OCT) IN DIFFUSE UNILATERAL SUBACUTE NEURO R E T I N I T I S (DUSN) Garcia Carlos Alexandre (Federal University of Rio Grande do Norte), Gomes Henrique B Alexandre (Federal University of Rio G rande do Norte), Garcia Filho Alexandre Carlos (Federal University of Sao Paulo), Segundo Souza Paulo (Federal University of Rio Grande do Norte), Garcia Claudia Me Ana (Federal University of Rio Grande do Norte) Objective: To measure retinal nervous fiber layer (RNFL) thickness using OCT in patients with DUSN and correlate it with visual acuity. Methods: We measured RNFL thickness, using RNFL thickness (3.4) program and best corr ected visual acuity in patients with DUSN between January 2005 and December 2006. Results: A total of 38 patients, aged 9 - 42 years were selected, of which 20 had live worm. Mean RNFL was 71.55 +/- 27.26 in the DUSN eye and 103.07 +/- 20.66 in the contralateral eye (p<0.001). Pearson?s correlation between visual acuity and RNFL was r = 0.522 (p<0.001) in the DUSN eye and r = -0.097 (p=0.509) in the contralateral eye. Conclusion: late stage patients had decreased RNFL and visual acuity is diretly proportional to RNFL thickness in DUSN patients. Financial fundings: (None.) Conflict of interest: The authors do not have any financial interest Keywords: OCT, DUSN, Neuroretinitis.
PO2-11-09 OCULAR ECODOPPLER IN NORMAL VOLUNTEERS: A REVIEW AROUND THE WORLD Souza Ana Catarina Delgado de (Clinica Oftalmologica Zona Sul e Unive rsidade Federal de Pe rn a m buco) Just Eduardo (Universidade Federal de Pernambuco) Ventura Cabral de Catarina (Fundatao Altino Ventura), Brandt Teixeira Carlos (Universidade Federal de Pernambuco) Objective: To describe the results of blood flow velocities in retrobulbar vessels, obtained through ocular color ecodoppler, around the world. Material and methods: A review of ocular ecodoppler studies in the world`s literature was done and only the results of normal volunteers were analyzed. The following aspects were reviewed: country of the study, year of publication, number of eyes or patients, age, gender, type of instrument used and vessels studied. The parameters of blood velocity measured were: peak systolic, end diastolic and medium velocities, and resistance index of the superior ophthalmic artery (OA), sort posterior ciliar artery (SPCA) and the central retina artery (CRA); and also the minimal, medium and maximum velocities of the central retina vein (CRV). Results: Since 1989, 25 studies on ocular ecodoppler in normal volunteers, written in English, were reviewed, from the following c o u n t ri e s : United States, Japan, Fra n c e, Scotland, Taiwan, Germany, Great Britain, Turkey, Switzerland and Brazil. Seven different instruments were used and the number of patients varied between 10 and 189. All the velocities, especially the peak systolic, and the resistance index of the AO were higher than the ones of the SPCA and the CRA. Only nine studies described the results of the CRV and 15 described the results of the SPCA. Conclusion: Different values found in the studies suggest the necessity of standardization of the ocular ecodopplerfluxometry technique. Some important aspects should be: angle corrections, more precise programs of velocity analyze, standardization of the sample volume and the exact position of the transducer on the vessels. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Dopplerfluxometry, Eye, Retrobulbar Vessels
PO2-11-10 AN OCT CASE STUDY OF TREATMENT RESPONSE IN HYPOTONOUS UVEITIS Moutray Tanya N (Royal Victoria Hospital, Belfast) Williams A Michael (Royal Victoria Hospital, Belfast), Alarbi Mohammad (Royal Victoria Hospital, Belfast), Mahon Gerald (Royal Victoria Hospital, Belfast), Silvestri G (Royal Victoria Hospital, Belfast) Introduction and objectives: We present the ocular coherence tomogram (OCT) findings in an unusual case of acute, bilateral hypotony associated with anterior uveitis in a patient with psoriasis. Methods: Case report Results: A 45-year-old Caucasian man complained of bilateral blurred vision and ocular pain. On examination he was found to have bilateral anterior uveitis. One month later his uveitis had settled on topical dexamethasone, but his intraocular pressure was unrecordable in the right eye, and was 2mmHg in the left eye. Examination of the fundi revealed that the right disc was oedematous, with a serous retinal detachment inferiorly and chorioretinal
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Abstract Book folds in both eyes. The patient commenced on 80mg of oral prednisolone, along with topical dexamethasone and Atropine to both eyes, and later he was treated a subtenons injection of 40mg of triamcinolone acetonide to the right eye. Although his vision improved his intraocular pressures remained low at 5mmHg in the right eye and 8 mmHg in the left. The patient subsequently developed an acute intraocular pressure spike in the right eye of 30mmHg due to 360 degree posterior synechiae and YAG peripheral iridotomies were required. He continues to be on a reducing dose of oral prednisolone along with topical dexamethasone. His OCT findings have improved and his vision remains stable Conclusions: We illustrate the value of OCT in a case of ocular hypotony where the underlying pathological mechanism is unclear. We also describe the clinical and ultrasound findings in this case of ocular hypotony, and the possible mechanism behind hypotonous uveitis. OCT can be a useful investigation to use when following up patients with ocular hypotony Financial fundings: none Conflict of interest: none Keywords: Ocular coherence tomogram (OCT), uveitis, ocular hypotony
PO2-11-11 OPTICAL COHERENT TOMOGRAPHY AND INDOCYANINE GREEN FINDINGS IN PRESUMED TB ASSOCIATED ACUTE RETINAL EPITHELIITIS CHENG BOB C.L (Singapore national Eye Centre), LEE Mun-Wai ( S i n gapore National Eye Centre), WONG DORIC (Singapore National Eye Centre), CHEE SOON-PHAIK (Singapore National Eye Centre) Case Report: A 32 year-old female presented with sudden onset left central scotoma with a reduced Snellen visual acuity of 6/120. Ophthalmoscopy showed a juxtafoveal subretinal pale yellow nodule without subretinal blood, exudates or associated anterior chamber inflammation. Results: Investigations showed a positive mantoux reaction of 25mm induration. Full blood count, erythrocyte sedimentation rate, chest X-Ray, syphilitic and toxoplasma serology were normal. Optical Coherent Tomography showed abnormal foveal reflectivity involving the outer nuclear and photoreceptor layers as well as increased thickness of the retinal pigment epithelium. Fundus fluorescein angiography revealed transmission window defect with associated optic disc hyperfluorescence. Indocyanine green angiography demonstrated hypofluorescence corresponding to the lesion surrounded with multiple punctate hypofuorescencent lesions not apparent clinically or on fluorescein angiography. The patient was subsequently referred for anti-tuberculosis therapy. The lesion was complicated by the development of choroidal neovascular membrane (CNV) 2 months later with the presence of subretinal blood over the same lesion. Repeat angiography confirmed the finding of classic CNV. The patient underwent photodynamic therapy with successful closure of the CNV. Conclusion: Acute retinal epitheliitis is a rare manifestation of presumed ocular tuberculosis. There was no spontaneous resolution and the lesion was complicated with development of CNV. Financial fundings: NIL Conflict of interest: NIL Keywords: TB, Retinal Epitheliitis
PO2-11-12 ULTRASOUND BIOMICROSCOPY AND ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY IN SCLERITIS: A CASE REPORT. Rozenbaum Ilya M. (The New York Eye and Ear Infirmary), Latkany A. Paul (The New York Eye and Ear Infirmary) Purpose: To report an unusual case of unilateral scleritis and panuveitis and describe ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) appearance of a ciliary body fluid collection. Methods: Case report. A 13-year-old male developed unilateral post-traumatic panuveitis and scleritis associated with a localized ciliary body fluid collection. The affected area was imaged using UBM and AS-OCT. The period of follow-up was 8 months. Results: Aqueous fluid culture and gram stain were positive for Staphylococcus epidermidis . High-frequency ultrasound-guided biopsy of sclera and ciliary body showed non-specific non-granulomatous chronic inflammation. The patientâ&#x20AC;&#x2122;s ocular inflammation persisted despite treatment with high dose topical and oral corticosteroids, oral non-steroidal anti-inflammatory drugs, and local and oral wide-spectrum antibiotics. Conclusions: This is an unusual case of panuveitis and scleritis refractory to multiple treatment modalities. Imaging with UBM and AS-OCT of a ciliary body fluid collection is described. Financial fundings: None Conflict of interest: None Keywords: scleritis, UBM, AS-OCT
PO2-11-13 FUNDUS AUTOFLUORESCENCE AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY Bat i oglu Fi gen (Ankara Unive rsity Faculty of Medicine Department of Ophthalmology), Ă&#x2013;zmert Emin (Ankara University Faculty of Medicine Department of Ophthalmology), Kurt Rengin ( A n k a ra Unive rsity Faculty of Medicine Dep a rtment of Ophthalmology), Astam Neslihan (Ankara University Faculty of Medicine Department of Ophthalmology) Introduction and objectives : To report a case of bilateral acute posterior multifocal placoid pigment epitheliopathy and to evaluate fundus autofluorescence and optical coherence tomography (OCT/SLO) findings in the acute and resolution phase. Method : A 21 year-old woman with a complaint of decreased vision in her both eyes underwent complete ophthalmological evaluation including color fundus photography, fundus fluorescein angiography, and autofluorescent imaging at baseline and followup visits. OCT/SLO was performed one month after her initial presentation. The correlation of the fndings on presentation and changes after resolution is performed using the results of these investigational techniques. Results: Fundus examination showed a pattern of multiple, limited creamy-yellow placoid lesions distributed over the posterior pole and the diagnosis of acute posterior multifocal placoid pigment epitheliopathy was established. Autofluorescence revealed early decreased fluorescence due to masking effect. OCT/SLO images showed areas of moderately increased backscattering in the outer nuclear layer corresponding hypoautofluorescent areas indicating subacute lesions. As the lesions began to resolve, there was central hyperautofluorescence within the lesions surrounded by a uniform
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Abstract Book zone of decreased autofluorescence. Irregularities and ondulation in the contour of the external high reflective band, areas of disruption of the IS/OS junction and thinning of the outer nuclear layer were prominent OCT findings corresponding to the hyperautofluorescent areas of the healing lesions bilaterally. Conclusion: Fundus autofluorescence changes show alterations on the RPE level suggesting that RPE may be primarily involved in the course of the disease. OCT/SLO shows outer retinal involvement as well as photoreceptor and RPE atrophy during healing and after disease resolution. The combined use of these new non-invasive technologies may help in the explanation of the histopathology and aetiology of APMPPE. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Acute posterior multifocal placoid pigment epitheliopathy, fundus autofluorescence, optical coherence tomography
PO2-12-01 BEVACIZUMAB IN PATIENTS WHITH DIABETIC MACULAR EDEMA Authors: B. Bajaire, A. Leon, A.Zabaleta. Afiliation: Olsabe Ophthalmologic Center, Oftalmosanitas, San Martin Unive rsity Ophthalmology Departament, Bogota Colombia. Proposal: Evaluate the functional and anatomical effect of Bevacizumab in patients with Diabetic Macular Edema. Materials and method: Prospective analysis of 11 eyes with Diabetic Macular Edema who received an intravitreal injection of bevacizumab 2,5 mg. The visual acuity, the anatomical result analyzing change of the macular thickness for Optical Coherent Tomography and adverse effects was evaluated to the patients from 3 to 6 months after the treatment. Results: The initial visual acuity of 11 eyes who received the medicament was minor 20/200 in 3 eyes (27.2%), 20/200 to 20/50 in 6 eyes (54.5%), the best or iqual 20/40 in 2 eye (18.2%), the visual acuity in the 11 eyes after 3 to 6 moth after the medicament injection was minor 20/200 in 1 eyes (9.1%) in the 20/200 to 20/50 group was 7 eyes (63.6%) and 3 eyes (27.2%)had the best or iqual 20/40. The initial macular thickness varied between 1000um and 203um with a 468um average. The macular thickness after the injection varied between 904 and 164 um with a 345um average, achieving a decreased in the macular thickness close to 123um (15.2% ) average. There were not complications neither intra nor postoperative to the bevacizumab injection. Conclusions: The intravitreal Bevacizumab decreased 15.2% the retinal macular thickness and improved of the function in 36.4% eyes with Diabetic Macular Edema without any adverse effect neither intra nor postoperative to the injection. Financial fundings: none Conflict of interest: none Key words: Diabetic Macular Edema, B evacizumac, Macular Thickness
PO2-12-02 PROTEOMIC ANALYSIS REVEALS AN ANTI-INFLAMMATORY COMPONENT OF DIABETIC RETINOPATHY Fort Patrice E., Singh S.J. Ravi, Losiewicz K. Mandy, Freeman M. Willard, Kimball R. Scot , Gardner W. Thomas Introduction: The aim of the study was to investigate the retinal proteome regulation during the early stages of insulin-deficient diabetes in two rodent models. The retina has a high metabolic rate and re q u i res continual protein synthesis to maintain cellular integrity and visual processes. Inflammatory processes and protein synthesis regulation are closely associated in diverse pathologies, including auto-immune diseases like diabetes. Methods: Global rates of protein synthesis were compared in retinas of streptozotocin-diabetic rats and Ins2Akita mice and agematched controls using the flooding dose technique to measure incorporation of H3-phenylalanine into proteins following intrafemoral or intra-peritoneal administration. Transcriptional profiles were assessed using whole genome Codelink microarrays and mRNA expression levels were confirmed using real-time RT-PCR. DIGE 2D-gels method was used to characterize the proteome modifications in the retina of diabetic rats compared to their agematched controls. Western-blot analysis was used to confirm levels of protein expression. Effects of systemic insulin administration was also assessed using western-blot methods. Results: The global rate of retinal protein synthesis (Ks) was progressively reduced (50 - 70% of control values) after 8 and 12 weeks of diabetes in the diabetic rats, and after 4 weeks of diabetes in the Ins2Akita mice. Systemic insulin therapy restored the Ks to control values. Additionally, microarray analysis of retinal RNA expression demonstrated increases in several transcripts including several chaperone proteins such as crystallins. Use of proteomic and western-blot approaches confirmed the observation of a dramatic increase of the expression of the proteins of the crystallin family. Conclusions: This study shows for the first time that the overall retinal protein synthesis is decreased in diabetes and that this global decrease is correlated with an increased expression of antiinflammatory proteins such as crystallins. These results suggest that early stages of diabetes are not only characterized by proinflammatory but also by anti-inflammatory events. Financial fundings: ADA, JDRF Diabetic Retinopathy Center, NIH DK15658 Conflict of interest: (None.) Keywords: diabetic retinopathy, protein synthesis, crystallins
PO2-13-02 PH OF THE CORNEA AND INFECTIOUS CORNEAL ULCERS Kovalevskaya Maria Alexandrov (Voronezh N. N. Burdenko State Medical Academy) Introduction: the effectiveness increase of bacterial and viral corneal ulcers diagnosis on the basis of studying the acid-base condition of the cornea. Methods: 4 groups of patients were evaluated for infectious corneal ulcers by contact electrochemical registration of corneal pH by pH/meter HI 8314 and 3mm- glass electrode HI 1083B (Hanna instruments, Switzerland). Error: +0,01. The 1 group - Chlamydial corneal marginal ulceration (49 patients). The 2 group Acanthamoeba infection of the contact lenses wearers (10). The 3
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Abstract Book group - Gonorrhea corneal ulcers (13). The 4 group - viral corneal ulcers (168 patients).Ulcer characteristics, culture results, and treatment data were collected. Results: Values of the corneal ulcers pH in the first group of patients with Chlamydial infection were increased (8,07+0,01).In the patients with viral corneal ulcers the indices of pH were not more than results of registration of healthy people during first three days of the disease(7,22+0,01). On fifth day of the course of viral infection the indices of corneal pH were increased to 8,02 +0,01 of 86% of patients. 13 patients with Gonorrhea corneal ulcers had the level of the corneal pH indices in the group with viral ulcers but was reliably lower while contamination by Acanthamoeba (7,34 +0,01) among 72% of patients of the second group. Conclusions: The dynamics of pH level of the infectious corneal ulcers makes it possible to evaluate preliminary the degree and type of acid-base corneal disorders during different infections of the organ of vision. Financial fundings: money of individual trade person-Pro f. Kovalevskaya Maria, medical center "Prozrenie". Conflict of interest: No conflicts Keywords: pH, cornea, ulcers
PO2-13-04 THE MICROBIOLOGICAL FEATURES OF MIXED INFECTION IN CONJUNCTIVA. D e d ova Julia N. (Voronezh N. N. Byrd e n ko State Medical Academy), Kovalevskaya A. Maria (Voronezh N.N. Byrdenko State Medical Academy)
tions in the cystic fibrosis transmembrane regulator (CFTR), encoded on the long arm of chromosome 7. The pathogenesis of ocular changes in CF is still unknown but cystic fibrosis belongs to the large pathologic group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca.The aim of this study was to evaluate the levels of MIP-1 alfa (macrophage inflammatory protein-1 alfa) in tear fluid of CF patients. We also investigated the correlation between the tear levels of this chemokine and clinical severity of CF and ocular surface disease. Methods: We studied twenty patients with CF. Chemokine levels were determined by ELISA.Complete ophthalmic examination, including dry eye tests, were used to study the ocular surface. Results: The tear levels of MIP-1 alfa in the CF patients were significantly higher when compared with healthy controls. We found a negative correlation between the tear levels of MIP-1 alfa and clinical severity in CF patients, and a positive correlation between the tear levels of MIP-1 alfa and the presence of dry eye findings in CF patients. Conclusions: This current study indicates that chemokines play an important role in the ongoing inflammatory response. Our findings may help to explain one of the key factors contributing to the pathogenesis oc ocular surface changes in CF patients. Financial fundings: This work was supported by a grant from the Ministry of Science and Higher Education (No. N406 051 31/1894) Conflict of interest: NO Keywords: Cystic fibrosis, chemokines, inflammation
PO2-13-06 Objectives: to evaluate the microbiological features of mixed infection in the chronic eye infected patients. Methods: isolation of bacteria was performed in 2150 samples of chronic conjunctivitis at two eye clinics in Voronezh region, RF. For microbiological diagnosis- DII, PSR, Gram-stained smears were performed. Results: Ureaplasma and Mycoplasma were isolated in 19% of cases, Neisseria gonorrhoeae and Protozoa-infection – in 14%, Chlamydia trachomatis and Ureaplasma- in 27%. Conclusions: from these results, it is suggested that the most common causing chronic eye infection is mixed bacterial associations, but proportion of multiple infections was not more 10% of all samples. Financial fundings: (None.) Conflict of interest: (None.) Keywords: mixed, bacterial, associations
PO2-13-05 TEAR FLUID LEVELS OF MIP-1 ALFA IN PATIENTS WITH CYSTIC FIBROSIS Mrugacz Malgorzata (Department of Pediatric Ophthalmology Medical Unive rsity of Bialystok) Mrugacz Malgo r z at a (Department of Pediatric Ophthalmology Medical University of Bialystok), Bakunowicz-Lazarczyk Alina (Department of Pediatric Ophthalmology Medical University of Bialystok), Wysocka Jolanta (Department of Pediat ric Lab o rat o ry Diagnostic Medical University of Bialystok), Kaczmarski Maciej (IIIth Department of Childhood Diseases Medical University of Bialystok) Introduction and objectives: Cystic fibrosis (CF) is the commonest, multi-system genetic disease of white races caused by muta-
THE IMBALANCE BETWEEN PRO-OXIDANT AND ANTIOXIDANT ENZYMES IN CONJUNCTIVAL EPITHELIUM OF PATIENTS SUFFERING FROM DRY EYE (SJÖGREN’S SYNDROME) Ardan Taras (Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Prague, Czech Republic), Cejkova Jitka (Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Prague, Czech Republic) Cejka Cestmir (Institute of Experimental Medicine, Academy of Sciences of the Czech Republic, Prague, Czech Republic), Malec Jiri (Department of Ophthalmology for Children and Adults, Motol Hospital, Charles University, 2nd Medical School, Prague, Czech Republic), Dotrelova Dagmar (Department of Ophthalmology for Children and Adults, Motol Hospital, Charles University, 2nd Medical Sch o o l , Prag u e, Cze ch Republic), Filipec Martin ( L ab o ratory and Ocular Tissue Bank, Department of Ophthalmology, General Teaching Hospital and Charles University, Prague, Czech Republic) Introduction and Objectives: The dry eye syndrome is a chronic ocular surface disease characterized by the deficiency of aqueous tears. The factors leading to the tear film deficiency may involve an autoimmune disease (e.g. n, SS), loss of hormonal support and glandular inflammation. We found previously that as compared to conjunctival epithelium of normal eyes, the activities of xanthine oxidoreductase/xanthine oxidase, enzymes known to generate reactive oxygen species, were highly increased in conjunctival epithelial cells of patients suffering from dry eye, SS. Purpose of this study was to detect the expression of antioxidant enzymes (scavengers of reactive oxygen species) in conjunctival epithelium. Methods: Superoxide dismutase, glutathione peroxidase and catalase were detected in conjunctival epithelial cells using immunohistochemical methods. Conjunctival epithelial cells on Millicells
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Abstract Book from patients with dry eye were obtained using the method of impression cytology. Normal eyes served as controls. Results: In 50-60% of conjunctival cells of patients with SS the immunohistochemical expression of antioxidant enzymes was less pronounced (particularly that of catalase) as compared to cells from healthy eyes. Conclusions: Even if further studies are necessary, our results point to the suggestion that reactive oxygen species generated in increased amount e.g. by xanthine oxidoreductase/xanthine oxidase and/or infl a m m at o ry cells are insuffi c i e n t ly cleaved due to decreased amount of antioxidant enzymes contributing to the oxidative damage of the eye surface. Financial fundings: This study was supported by a grant from the Ministry of Health of the Czech Republic No. NR/8828-3 and by a grant from the Grant Age n cy of the Cze ch Republic No. 304/06/1379. Conflict of interest: (None.) Keywords: dry eye, Sjören’s syndrome, antioxidant enzymes
PO2-13-07 IN VIVO CONFOCAL MICROSCOPY OF PATIENTS WITH THYGESON'S SUPERFICIAL PUNCTATE KERATITIS Labbé Antoine (Quinze-Vingts National Ophthalmology Hospital, Paris, France.), Baudouin Christophe (Quinze-Vingts National Ophthalmology Hospital, Paris, France.), Amar Nawel (QuinzeVingts National Ophthalmology Hospital, Paris, France.), Doan Serge (Rothschild Ophthalmologic Foundation, Paris, France.), Hoang-Xuan Than (Rothschild Ophthalmologic Foundation, Paris, France.), Gabison Eric (Rothschild Ophthalmologic Foundation, Paris, France.) Introduction and objectives: To analyze corneal changes in patients with Thygeson's superficial punctate keratitis using in vivo confocal microscopy. Methods: Twenty four eyes of 12 patients (7 females and 3 males) with Thy geson's superficial punctate ke ratitis we re incl u d e d. Ophtalmologic examinations included slit-lamp examination and in vivo confocal microscopy. Results: In all pat i e n t s , slit-lamp biomicro s c o py of Thygeson?s superficial punctate keratitis revealed epithelial cell cl u s t e rs with a round - or oval- shaped grey and granular appearance. Absence of conjunctival or corneal infl a m m ation and/or scarring was noted in all p atients. In vivo confocal micro s c o py images showed in the superficial epithelium round and/or oval shaped zones of hyper- re flective and ab n o rmal epithelial cells. Deeper in the anterior stroma, round a reas of hyper-reflective keratocytes we re observed under the epithelial lesions. The corneal nerves seemed unmodifi e d. A bundant dend ri t i fo rmcells we re detected in the affected subepithelial area. Conclusions: Although Thy geson's superficial ke ratitis is described as a non inflammatory disease, numerous inflammatory cells associated with hyper-reflective epithelial structures were observed within the epithelium and activated keratocytes were constantly detectable in the subepithelial stroma. In vivo confocal micro s c o py is providing new insight into the analysis of Thygeson's superficial keratitis. Financial fundings: (None.) Conflict of interest: (None.) Keywords: In vivo confocal microscopy, thygeson's keratitis, ocular surface.
PO2-13-08 EVALUATION OF AMNIOTIC MEMBRANE TRANSPLANTATION IN ACUTE CHEMICAL AND THERMAL BURNS G avala Caterina (ippocratio ge n e ral hospital), N i ko s Kiriakopoulos (ippocratio general hospital), Patiakas Stefanos (ippocratio general hospital), Akritopoulou Kiriaki (ippocratio general hospital), Georgantis Hlias (ippocratio general hospital), Akritopoulos Panagiotis (ippocratio general hospital) Introduction and objectives: To report ocular surface wound healing after fresh amniotic membrane patching for acute chemical and thermal burns. Methods: 12 eyes of 11 male patients between 22 and 45 years of age were included in our study fro Januar y 2005 to February 2007.10 eyes presented whole corneal burn above degree II, with incomplete but severe destruction of the limbus, and 2 complete limbal destruction as well as conjunctiva and anterior sclera involvement. Monolayer patch implantation was performed in all 12 eyes within 15 days after injury. Results: Complete epithelialization was achieved within 2 weeks in 11 of 12 eyes. In 1 eye, which presented complete limbal destruction, amnion was dissolved due to persistent epithelial defects. Visual acuity showed improvement 10 days after surgery in 11 of 12 eyes. In 1 eye scarring sequelae were developed with time, such as superficial corneal neovascularization. None experienced symblepharon. Conclusions: Monolayer patch amniotic membrane transplantation has resulted efficient in fast epithelialization preventing corneal ulceration, reducing limbal stromal inflammation in the acute stage of burn injury, and probably debilitating symblepharon. Financial fundings: (None.) Conflict of interest: (None.) Keywords: amniotic membrane, wound healing, burn
PO2-13-09 INCREASED COMPLEMENT CONCENTRATIONS IN TEARS OF PATIENTS WITH SJÖGREN SYNDROME Yamada Masakazu (National Institute of Sensory Organs, National Tokyo Medical Center), Mochizuki Hiroshi (National Institute of Sensory Organs, National Tokyo Medical Center), Yoshida Junko (National Institute of Sensory Organs, National Tokyo Medical Center), Hatou Shin (National Institute of Sensory Orga n s , National Tokyo Medical Center), Tojo Hiromasa (Department of Biochemistry and Molecular Biology, Osaka University) Objectives: Recent studies have demonstrated that conjunctival inflammation has an important role in the pathogenesis of dry eye syndrome. The complement system, a key element of the humoral immune system, is known to be present in tears. We examined the level of complement in tears of patients with Sjögren syndrome. Methods: Sixteen patients with Sjögren syndrome and 14 agematched normal control subjects participated in this study. Tears were collected with a Schirmer’s test strip from the right eye of each subject. A solvent consisting of a 50:50 mixture of 0.2% trifluoroacetic acid and acetonitrile was used to extract proteins. An enzyme linked immunosorbent assay was used to determine C3 and C4 levels in tear samples. Total protein concentrations were assayed with a bicinchoninic acid technique. Results: The levels of C3 and C4 in tears of Sjögren syndrome
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Abstract Book were g/mL, re s p e c t ively, which wereÌg/mL and 69.0±24.0? Ì96.3±23.8? g/mLÌsignificantly higher than those of normal controls (48.4±24.6 ? g/mL, respectively). The mean concentration of totalÌand 19.3±6.8? protein in patients with Sjögren syndrome was 10.1±4.3 mg/mL, which was significantly lower than that of normal controls (14.9±3.8 mg/mL). Conclusions: This study has demonstrated increased complement concentrations in tears of patients with Sjögren syndrome. Our results suggest that complement might be involved in the mechanism of conjunctival inflammation in Sjögren syndrome. Financial fundings: Supported in part by a grant from Ministry of Education, Culture, Sports, Science and Technology, Japan Conflict of interest: None Keywords: complement, dry eye, Sjögren syndrome, tears
PO2-13-10 ONE MONTH THERAPY WITH SYSTANE IMPROVES OCULAR SURFACE PARAMETERS IN DRY EYE PATIENTS Versura Piera (Dept Ophthalmology Alma Mater Studiorum University of Bologna) Profazio Vincenzo, Campos C Emilio Introduction and objectives: Systane® Lubricating Eye Drops (Alcon Forth Worth, Inc.) contains the PEG400/PG and the gelling agent hydroxypropyl-Guar (HP-Guar) that is believed to mimic the mucin layer of the tear film and it was designed to provide patient relief by means of longer retention time on the ocular surface. We evaluated Systane in an open trial in patients complaining of mod erate symptoms. Methods: A total of 50 subjects were enrolled (age 57.6 ± 15.4; 40 women, 10 men); inclusion criteria were based on tear break-up time (TBUT)< 10 sec without corneal epithelial staining. Six symptoms of ocular irri t ation were rated on a four-point scale. Conjunctival hyperemia was graded. Patients were instructed to instill Systane four times a day for four weeks. Satisfaction with the product was rated at the end of the study. Media of results in both eyes was considered for statistical evaluation; the Wilcoxon test for paired data was applied, p< 0,05 was considered as statistically significant. Results: All subjects regularly instilled Systane and completed the follow-up; results are expressed baseline vs endpoint. Significant reduction was demonstrated for ocular irritation symptom scores (1.44 vs 0.94, p 0.0001) while improvement was shown for patient’s satisfaction score (3.41 vs 3.94, p 0.0001) and TBUT (6.9 ± 0.9 vs 8.5 ± 1.5 sec, p 0.0001). A significantly increased proportion of patients with normal conjunctival injection (10 vs 22, results in %, p 0.01) was observed after one month follow up. Conclusions: Systane proved effective in reducing the symptoms of dry eye and it was overall well accepted. This finding is likely to be related with improved stability of tear film, due to the protective viscous layer bound to the corneal surface. Financial fundings: Alcon Conflict of interest: (None.) Keywords: Ocular surface, dry eye, lubricating eye drops
PO2-13-11 USE OF AUTOLOGOUS PLATELET RICH PLASMA IN THE TREATMENT OF CHEMICAL CONJUNCTIVITIS Ferrer Consuelo (Vissum, Instituto Oftalmologico de Alicante) R o d riguez E Alejandra (Vissum, Instituto Oftalmologico de Alicante), Feijoo Bernando (Vissum, Instituto Oftalmologico de Alicante), Rodriguez-Prats L Jose (Vissum, Instituto Oftalmologico de Alicante), Mezquida Gloria (Vissum, Instituto Oftalmologico de Alicante), Alio L Jo rge (Vissum, Instituto Oftalmologico de Alicante) Introduction and objectives: To report a case of chronic chemical conjunctivitis caused by a defense spray and treated with platelet rich plasma. Methods: A 58 year-old woman presented with ocular injury two days after an assault with a defense spray. The spray was composed of O-chlorobenzylidene malononitrile (4,8%) and metil-eti-ketone (45%). On examination, severe conjunctival hyperemia and tear discharge were noted in both eyes. There was also superficial punctacte keratitis. Best-corrected visual acuity (BCVA) of the right eye was 0.2 and of left eye was 0.3. The patient was started on topical corticosteroid and antibiotic eye drops (Tobradex®) and chloramphenicol ointment at bedtime. Results: After 2 weeks of treatment, the patient was still highly symptomatic and presented persistent inferior severe conjunctival hyperemia with mucous secretion, without corneal affectation. Conjunctival impression cytology revealed an important decrease in goblet cell population, mainly in the inferior bulbar conjunctiva. The patient was started on autologous platelet-rich plasma eye drops, in addition to Tobradex®. After two months of treatment there was a marked improvement in symptomatology and a significant decrease in conjunctival hyperemia. Conclusions: O-chlorobenzylidene malononitrile, a common compound of defense sprays, can cause severe and persistent conjunctival inflammation. The use of autologous platelet rich plasma proved to be an appropriate treatment in this case. Financial fundings: None Conflict of interest: None Keywords: conjunctivitis, defense spray, platelet-rich plasma
PO2-13-12 FUNGAL KERATITIS: A REVIEW OF THIRTY-FOUR CASES. Zaouali Sonia (Fattouma Bourguiba University Hospital, Monastir, Tunisia), C h a o u ch Ahmed (Fattouma Bourguiba Unive rs i t y Hospital, Monastir, Tunisia), Jenzeri Salah (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Barkia Imen (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Ben Amor Hajer (Fattouma, Bourguiba Unive rsity Hospital, Monastir, Tunisia), K h a i rallah Moncef (Fattouma Bourguiba Unive rs i t y Hospital, Monastir, Tunisia) Introduction and objectives: To describe the risk factors, clinical features, treatment strategy and prognosis of fungal keratitis. Methods: We retrospectively reviewed the medical records of 34 patients (37 eyes) treated for fungal keratitis from March 2004 to December 2006 at the Department of Ophthalmology of Monastir (Tunisia). All patients underwent a detailed ophthalmic examination and microscopic detection of fungal elements in corneal scraping. Results: The mean age was 56 years (range, 22-80 years). Sex ratio
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Abstract Book (F/H) was 1.83. Eight patients (24%) were diabetic. Ocular trauma was the predisposing factor in 15 patients (44.1%). The mean delay between the onset of the disease and diagnosis was 18 +/- 7 days. Initial visual acuity was < 20/200 in 27 eyes (73%). Identification of fungal elements was achieved in 11 eyes (29.7%). Fusarium solani was the most commonly isolated organism (6 eyes, 54.5%), fo l l owed by A s p e rgillus fumigatus (4 eye s , 36.4%) and Acremonium (1 eye, 9.1%). The most commonly used treatment was topical amphotericin B. One patient underwent penetrating keratoplasty. After treatment, visual acuity improved in 16 eyes (43.2%). Conclusions: Fungal keratitis is an important cause of ocular morbidity. Its prognosis is related to early diagnosis and prompt management with antifungal agents. Prevention remains the best treatment. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Fungal Keratitis, Fusarium solani, Aspergillus fumigatus
PO2-13-13 SCLERAL CONTACT LENSES IN THE MANAGEMENT OF OCULAR SURFACE DISORDERS AFTER STEVENSJOHNSON SYNDROME AND TEN Gueudry Julie (Dept of Ophthalmology, University Hospital Charles Nicolle, Rouen, France) Brousseau Bénédicte (Dept of Ophthalmology, Unive rsity Hospital Charles Nicolle, Rouen, France), Delcampe Agnès (Dept of Ophthalmology, University Hospital Charles Nicolle, Rouen, France), Laroche J-M (Dept of Ophthalmology, Fondation Ophtalmologique A. de Rothschild and Bichat Hospital, APHP, Paris, France), Hoang Xuan Than (Dept of Ophthalmology, Fondation Ophtalmologique A. de Rothschild and Bichat Hospital, APHP, Paris, France), Muraine Marc (Dept of Ophthalmology, Unive rsity Hospital Charles Nicolle, Rouen, France) Introduction and objectives: to describe our experience in the use of scleral contact lenses in patients with corneal surface disease after Stevens-Johnson syndrome and TEN. Patients and method: In this prospective study, 64 eyes of 36 patients with ocular complication after Stevens-Johnson syndrome and TEN were fitted with an extended-wear gas-permeable scleral lens. We used a copolymer of metacry l ates and fl u o rine comonomer (Laborat o i re LPO, Thonon les Bains - France). Fluorescein staining and photography of the ocular surface was performed in each cases. Visual acuity, symptoms of ocular discomfort and the Ocular Surface Disease Index were noted. Results: The mean age of the 36 patients was 35.8 years (range 7 to 65 years). Follow up was 23.5 months. The functionality of tearfluid interchange was confirmed in all cases by observing the passage of fluorescein dye from the fornix into the fluid compartment. Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 44 eyes (68%), 32 patients (90%) report a marked relief of ocular discomfort, 28 patients (78%) noted a marked reduction in photophobia with the use of gas-permeable scleral contact lenses. Thirty-four patients (95%) of the 36 patients reported improvement in their quality of life. OSDI score improved from 75.3 to 39 (p<0.05). Conclusion: We find that gas-permeable scleral contact lens wear is an additional effective strategy in the management of ocular surface problems in the visual rehabilitation of patients with severe ocular surface disease after Stevens-Johnson syndrome and TEN .
Financial fundings: none Conflict of interest: none Keywords: TEN, Stevens-Johnson syndrome, scleral contact lenses
PO2-13-14 PERIPHERAL ULCERATIVE KERATITIS: A REVIEW OF 12 CASES Attia Sonia (Fattouma Bourguiba University Hospital Monastir Tunisia), Dimassi Raafa (Fattouma Bourguiba University Hospital Monastir Tunisia), Jeguirim Houyem (Fattouma Bourg u i b a University Hospital Monastir Tunisia), Tritar Zohra (Fattouma Bourguiba University Hospital Monastir Tunisia), Zaouali Sonia (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia), K h a i rallah Moncef (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia) Introduction and objectives: analyze the clinical characteristic, management, and outcome of peripheral ulcerative keratitis (PUK). Methods: A retrospective study was undertaken of all patients with a diagnosis of PUK at the department of Ophthalmology of Monastir (Tunisia). All patients underwent a complete ophthalmic examination. Systemic evaluation, including physical examination and laboratory screening investigations, was performed. Results: Twelve patients with PUK were identified. The mean age at presentation was 49 years. There were 1 male (8.3%) and 11 female (91.7%). PUK were unilateral in 9 patients. Mean follow-up was 38 months. The main presenting symptoms were pain (10 patients) and a decreased vision (8 patients). Initial visual acuity was 60/200 in all patients. Thirteen eyes (86.6%) had peripheral corneal ulcer. Ulcers were mild to moderate in depth (25% to 50% of corneal thickness) in 11 eyes (73.3%) and severe in 4 eyes (26.6%). Other associated clinical features include keratoconjunctivitis sicca (9 eyes; 60%), anterior scleritis (1 eye; 6.6%), necrotizing scleritis (1 eye; 6.6%), scleromalacia perforans (1 eye; 6.6%), granulomatous anterior uveitis (1 eye; 6.6%). Systemic evaluation revealed a rheumatoid arthritis in 8 patients, systemic lupus erythematosus in 1 patient, psoriatic arthritis in 1 patient, and pemphigoid in 1 patient. Mooren’s ulcer was diagnosed in 1 patient. Medical management included topical corticosteroids in all patients, systemic corticosteroids (8 patients) and/or immunosuppressive therapy (2 patients). None patient had surgical treatment. Thirteen eyes (86.6%) had epithelial healing. PUK progressed to corneal perforation in 2 eyes (13.3%). Final visual acuity was ? 40/200 in 12 eyes (80%). Conclusions: PUK was associated with systemic vasculitis in most cases. A complete physical examination and laboratory testing should be performed in these patients in order to search for the underlying systemic disease. Financial fundings: none Conflict of interest: none Keywords: Peripheral, Ulcerative, Keratitis
PO2-13-15 SPECTRUM OF BACTERIAL KERATITIS IN A REFERRAL CENTER IN TUNISIA, NORTH AFRICA Attia Sonia (Fattouma Bourguiba University Hospital Monastir Tunisia), Hasnaoui Wafa (Fattouma Bourguiba University Hospital Monastir Tunisia), Hmidi Kamel (Fattouma Bourguiba University Hospital Monastir Tunisia), Dimassi Raafa (Fattouma Bourguiba University Hospital Monastir Tunisia), Gargouri Salma (Fattouma
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 131
Abstract Book Bourguiba University Hospital Monastir Tunisia), Khairallah Moncef (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia) Introduction and objectives: To report the epidemiological features, clinical characteristics, laboratory findings, and treatment outcomes in patients with bacterial keratitis in Tunisia, North Africa. Methods: The study included 91 patients (91 eyes) with bacterial keratitis examined at the department of Ophthalmology of Monastir (Tunisia) from January 1995 to January 2007.The medical records of all patients were reviewed retrospectively for demographic features, risk factors, clinical characteristics, laboratory findings, treatment strategy, and outcome. Results: The mean age was 52.5 years. There were 53 male (58.2%) and 38 female (41.8%). Most common risk factors included were: corneal trauma (38.5%), especially injury from plants (48.5%), pre-existing ocular disease (26%), and inadequate use of topical steroid (8.8%). Diabetes mellitus was found in 11 patients (12.1%). Initial visual acuity was > 20/200 in 17 eyes (18.7%) and 20/200 in 74 patients (81.3%). Fifty eyes (54.9%) had central corneal ulcer. The diameter of corneal ulcer ranged from 3.5 to 11 mm. Eight eyes (8.8%) had larger ulcers (diameter > 6 mm). Forty eyes (52.6%) had hypopyon, 7 eyes (7.7%) had descemetocele, and 2 eyes (2.2%) had endophthalmitis. Pure bacterial cultures were obtained from 16 (17.58%) eyes. The bacterial isolates were of Streptococcus pneumoniae in 5 eyes followed by Staphylococcus epidermidis in 4 eyes and Pseudomonas aeruginosa in 4 eyes. Topical antibiotic, used in all patients, included either fl u o roquinolone antibiotics or combination fo rt i fied cephalosporin and aminoglycoside antibiotics. Penetrating keratoplasty was performed in 9 eyes (9.9 %). Globe integrity was preserved in 86 eyes (94.5%). Final visual acuity was > 20/200 in 44 eye (48.4%) and 20/200 in 47 patients (51.6%). Conclusion: Bacterial keratitis was more found to be culture negative in our patients and can lead to severe ocular disability. Prompt diagnosis and appropriate therapy can prev ent profound visual morbidity. Financial fundings: none Conflict of interest: none Keywords: Keratitis, Bacteria, Management
PO2-13-16 0.15% GANCYCLOVIR GEL IN THERAPY OF EPIDEMIC ADENOVIRAL KERATOCONJUNCTIVITIS CZAPLICKA Ewa L. (Dpt. of Ophthalmology Unive rsity of Medical Sciences Poznan /Poland) WASILEWICZ Robert (Dpt. of Ophthalmology University of Medical Sciences Poznan /Poland), KOCI¢CKI Jaros aw (Dpt. of Ophthalmology Unive rsity of Medical Sciences Poznan /Poland) Introduction and objectives: Reduced adenoviral-related mortality in human with anty-cytomegaloviral intra-venous prophylaxis after marrow transplantation proved gancyclovir anty-adenoviral activity. Lung adenoviral infections therapy in human after heart transplantation was also effective with its use. (Bruno and al.) (Duggan and al.). Topical gancyclovir eye-gel is employed in herpetic keratitis therapy. Pharmacokinetical data reveal that after gancyclovir QID topical administration its tissue concentration reach nearly therapeutical level for adenoviral replication inhibition. Those results let pro-
vide gancyclovir gel anty-adenoviral activity in epidemic keratoconjunctivitis after more frequent dosage. Aim: To evaluate in vivo 0,15% gancyclovir eye-gel effectiveness in therapy-rate and symblepharon/subepithelial precipitates presence prevention after epidemic adenoviral keratoconjunctivitis. Material and methods: 13 patients (24 eyes) with proved unilateral (2 persons) or bilateral (11 persons) epidemic keratoconjunctivitis fulfilling criteria: •viral superior air-ways infection or limphadenopathy within previous 2 weeks •typical punctate epitheliopathy (with fluoresceine staining) •positive RPS Adeno Schnelltest ( immunoassay) Therapy: 0,15% gancyclovir eye-gel administration 5 times/day into conjunctival sac until total punctate epitheliopathy healing, combined with its additional 4 times/day dosage for 1 week. Results: Epitheliopathy healed totally (no fluoresceine staining) within 3-5 days at 11 persons (21 eyes), in 16 eyes without subepithelial pre c i p i t ates pre s e n c e. Subepithelial precipi t ates we re detected in 8 eyes of 4 persons, in 3 of them infection has very severe course (epithelium healing time – 6-8 days) with symblepharon formation. Conclusion: In most cases 0,15% gancyclovir eye –gel reduce adenoviral-related corneal epitheliopathy healing time. Financial fundings: No Conflict of interest: No Keywords: ADENOVIRUS, GANCYCLOVIR, EPIDEMIC KERATOCONJUNCTIVITIS
PO2-13-17 THE USE OF SYSTEMIC SIGNAL TRANSDUCTION INHIBITORS IN TREATING ATOPIC KERATOCONJUNCTIVITIS Foster C. Stephen (Massachusetts Eye Research & Surge ry Institute, Cambridge, MA 02142) Anzaar Fahd (Massachusetts Eye Research & Surgery Institute, Cambridge, MA 02142), Gallagher Michael (Massachusetts Eye Research & Surge ry Institute, Cambridge, MA 02142), Bhat Pooja (Massachusetts Eye Research & Surge ry Institute, Cambri d ge, MA 02142), Arif Mansoor (Massachusetts Eye Research & Surgery Institute, Cambridge, MA 02142), Farooqui Saadia (Massachusetts Eye Research & Surgery Institute, Cambridge, MA 02142) Purpose: We describe a series of patients with severe atopic keratoconjunctivitis (AKC) associated with atopic dermatitis, resistant to conventional therapies, who were successfully treated with systemic T-lymphocyte signal transduction inhibitors. Methods: Observational case series of patients with chronic histories of atopic keratoconjunctivitis and atopic dermatitis who had failed conventional treatments, including immunomodulatory therapy. Approval from the Massachusetts Eye and Ear Infirmary Institutional Review Board was obtained for this study. The charts of patients with AKC assessed by one of the authors (CSF) were reviewed to identify those who were treated with systemic T cell signal transduction inhibitors. Visual acuities, previous treatments and the response to systemic signal transduction inhibitors was observed and reported. Results: Six patients were identified, with a mean duration of AKC for 22 years. All of them had failed topical and systemic corticosteroids and antihistamines, and had active dermatitis before the initiation of treatment. Three patients were treated with systemic cyclosporine, and three were treated with systemic tacrolimus. One patient was subsequently treated with daclizumab in addition to
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Abstract Book t a c ro l i mus. These patients demonstrated a significant clinical improvement in both dermatological and ocular symptoms, alongwith an increase in visual acuity in all cases. Conclusions: Selective immunosuppression of T lymphocytes (integral to the pathogenesis of atopic dermatitis and keratoconjunctivitis) with systemic cyclosporine or tacrolimus has proven to be an effective in the treatment of atopic dermatitis in the past. We report that they are also effective in the treating complications of atopic keratoconjunctivitis, and may also improve visual acuity. We advocate the use of systemic therapy in cases that are resistant to conventional treatment to resolve the underlying immunopathology and immune dysregulation in atopic patients if vision is to be preserved. Financial fundings: None Conflict of interest: None Keywords: atopic keratoconjunctivitis, immunomodulatory therapy, signal transduction
PO2-13-18 TREATMENT OF BACTERIAL CONJUNCTIVITIS BY AZITHROMYCIN DROPS. I Cochereau1, A Medder-Ouertani2, Moncef Khairallah3, Mihai Pop4, R Tandon5, P Goldschmidt6, PY Robert7. 1 CHU Angers, France, 2 H么pital Charles Nicolle, Tunis, Tunisia, 3 H么pital Fattouma Bourguiba, Monastir, Tunisia, 4 Spitalul Clinic, Bucharest, Romania, 5 Centre for Ophthalmic Sciences, Dehli, India, 6 CNO XV-XX, Paris, France, 7 CHU Limoges, France. Aim: To compare the efficacy and safety of Azyter庐, azithromycin 1.5% eye drops, for 3 days with tobramycin 0.3% for 7 days in the treatment of purulent bacterial conjunctivitis. Methods: This multicentre, randomised, inve s t i gat o r- m a s ke d study included 1,043 patients Children and newborns could be recruited. Azithromycin 1.5% twice-daily for 3 days was evaluated versus tobramycin 0.3%, 1 drop every two hours for 2 days, then four times daily for 5 days. The main clinical signs were conjunctival injection and purulent secretions. They were evaluated and conjunctival cultures with bacterial count were obtained at D0 (day 0), D3 (day 3) and D9 (day 9). Primary variable was the clinical cure defined as no bulbar conjunctival injection and no discharge at D9 in patients with D0-positive cultures. Results: In the per protocol set, among 471 patients with a D0-positive culture, 87.8% of the azithromycin 1.5% group and 89.4% of the tobramycin group were clinically cured at D9. Clinical and bacteriological cure rates were shown to be non-inferior for azithromycin in comparison with tobramycin. Additionnaly, at D3, clinical cure was significantly higher with azithromycin 1.5%. Azithromycin was well tolerated. Conclusions: The efficacy and safety of azithromycin 1.5% for 3 days was non inferior to tobramycin for 7 days. Additionnaly, azithromycin eye-drops ensure a more rapid clinical cure than tobramycin at D3. Due to its low daily dosing regimen (one drop in the morning and one drop in the evening) and short treatment duration (for 3 days), azithromycin 1.5% is a step forward in the management of purulent bacterial conjunctivitis, especially in children.
PO2-13-19 IMMUNOHISTOCHEMICAL STUDY ON ADENOVIRUS CONJUNCTIVITIS Yoshitsugu Tagawa, Masataka Akanuma, Takeshi Ohguchi,
Toshihide Ariga, Koki Aoki and Shigeaki Ohno Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, JAPAN Purpose To clarify the immunopathogenesis of human adenovirus conjunctivitis (HAC), we analysed the conjunctiva obtained from the patients with the acute stage of HAC immunohistochemically. Methods Four conjunctival tissues and one pseudomembrane from the patients with the acute stage of HAC were immunostained by immunoperoxidase method using several monoclonal antibodies againt lymphocyte subsets, Langerhans cells and imuunoglobulin of IgG and IgA. Results 1. Intensive infiltration of mononuclear cells were observed in all the specimensincluding pseudomembrane. Polymorph nuclear leucocytes were rarely observed. 2. CD4 of helper T cells were the predominant population of T cells including pseudomembrane. 3. Many L26 positive B cells were also seen. Many IgA and IgG positive cells were distributed in the stroma of conjunctiva and pseudomembrane. Conclusions It seems that CD4 T cells play a role in the acute stage of HAC and also active antibody productions of IgA and IgG occur in the conjunctiva. Keywords: adenovirus conjunctivitis, immunohistopathology, T cells
PO2-13-20 CLINICAL CHARACTERISTICS OF ADENOVIRUS KERATOCONJUNCTIVITIS_ T.Ohguchi, K.Aoki, Y.Tagawa, S.Ohno. Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Purpose: To clarify the clinical characteristics of adenovirus (hAdV) keratoconjunctivitis(KC), we compared the clinical findings of the patients with adenovirus KC with those with non adenovirus KC. Methods: We examined the clinical findings of 102 patients who were suspected to have adenovirus KC from August to October, 2003 and analysed the conjunctival swabs obtained from these patients by PCR method. As clinical findings we focused on five items such as bilaterality, incidence of intrafamilial infection, multiple subepithelial corneal infiltrates(MSI), preauricular lymphadenopathy and severity of conjunctivitis. Viral DNA was extracted from conjunctival swabs and then DNA restriction analysis was performed with eight kinds of restriction endonucleases. The entirety of each hexon gene and fiber gene was amplified by the PCR method and then the nucleotide sequences of the entire hexon and fiber genes were determined. Results: Out of 102 patients, 68 cases (66.7%) were potive for adenovirus by PCR method. Regarding the clinical findings, bilaterality(82.4% vs. 29.4%), intrafamilial infection(46.2% vs. 0%) and MSI(40% vs. 0%) were seen much higher in patients with
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Abstract Book adenovirus KC (P under 0.01). hAdV-8,19 and 37 were isolated from the patients with adenovirus KC. Conclusions: Clinical characteristics of adenovirus KC have been said to be follicular conjunctivitis, MSI and preauricular lymphadenopathy. However, the results of this study clearly indicate bilaterality, intrafamilial infection and MSI have more potent clinical values for the diagnosis of adenovirus KC._ Keywords: adenovirus keratoconjunctivitis, clinical characteristics,
PO2-15-01 AN EFFICIENT AND RELIABLE TECHNIQUE FOR THE PREPARATION OF CONCENTRATED TRIAMCINOLONE ACETONIDE FOR INTRAVITREAL INJECTION de Saint Sardos Alexandre (Département d'Ophtalmologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, PQ, Canada) de Saint Sardos Alexandre de Saint Sardos (Département d'Ophtalmologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, PQ, Canada) Sébag Mikaël (Département d'Ophtalmologie, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, PQ, Canada) Rhéaume Marc-André (Département d'Ophtalmologi e, C e n t re Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, PQ, Canada) Théoret Y ves (Département de Pharmacologi e, U n iversité de Montréal, Unité de Pharmacologie Clinique, CHU Ste-Justine, Montréal, PQ, Canada) Arbour Jean-Daniel (Département d'Ophtalmologi e, C e n t re Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, PQ, Canada) Introduction: To describe and evaluate a simple technique for the p rep a ration of concentrated triamcinolone acetonide (TA) fo r intravitreal injection. Methods: Vials of TA (40mg/mL; 5mL) were shaken and allowed to sediment for up to two days. At specific times (1, 3, 6, 12, 24 and 48 hours) the supernatant was removed. A sample of the remaining resuspended sediment was taken. The amount of TA and concentration of benzyl alcohol was verified by high performance liquid chromatography (HPLC) with diode array detection. Descriptive data was tabulated. Results: The average preparation time for the higher concentrate injectate was approximately two minutes. At time zero there was 4.13+/-0.3mg of TA in the 0.1mL samples. At one hour, the quantity of TA in a 0.1mL injection prepared as described increased to 8.76+/-0.25mg, while the concentration of benzyl alcohol remained constant (0.84+/-0.04%). By three hours the quantity of TA in 0.1mL was 18.4+/-0.58mg with 0.90+/-0.07% benzyl alcohol. After three hours there was no marked change in the quantity of TA or benzyl alcohol in the samples. The average amount of TA in all of the 0.1mL samples from 3 to 48 hours was 17.4+/-1.4mg and the concentration of benzyl alcohol was 0.89+/-0.07%. Conclusions: We describe a fast, reliable and simple method for preparing concentrated TA for intravitreal injection while decreasing the quantity of benzyl alcohol injected in the eye. Financial fundings: Fonds de Recherche en Ophtalmologie de l'Université de Montréal (FROUM) Conflict of interest: None Keywords: triamcinolone, intravitreal, concentration
PO2-15-02 CRYSTALLIZATION OF GANCICLOVIR AFTER INTRAVITREAL INJECTION Choopong Pitipol (Siriraj hospital, Mahidol university), Tesavibul Nattaporn (Siriraj hospital, Mahidol university) Objective: To report a novel case of ganciclovir crystallization and its toxicity after intravitreal injection. Methods: Case report and review of the literature. Results: A 73-year-old female presented with chronic unilateral anterior uveitis that did not respond to anti-inflammatory therapy. A polymerase chain reaction test of aqueous showed positivity to cytomegalovirus DNA and ganciclovir (4mg/0.04cc) were injected intravitreally afterward. Intraocular pressure increased immediately after the injection and rapid crystallization of ganciclovir was observed in the vitreous anterior to optic disc. Visual acuity dropped from 6/24 to finger counting. Immediate paracenthesis and early vitrectomy with intravitreal steroid injection were performed. Optic atrophy occurred 1 month later despite previous treatments. Her final visual acuity was finger counting at 1 foot. Conclusions: Ganciclovir may forms crystal when injected intravitreally and permanently damages both retina and optic nerve. Financial fundings: None of the authors has any funding in any of the products or devices used in this study. Conflict of interest: None of the authors has any proprietary or financial interest in any of the products or devices used in this study. Key wo rd s : ga n c i clovir toxicity, intravitreal injection, cytomegalovirus
PO2-15-03 INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION IN PATIENTS WITH RECURRENT INTERMEDIATE UVEITIS AND BEHCET’S DISEASE Moonjeong Choi (Kim's eye Hospital), Tae Gon Lee (Kim's eye Hospital) Purpose: The purpose of this study is to analyze the effects and the complications of the intravitreal injection of triamcinolone acetonide (IVTA injection) in recurrent intermediate uveitis and Behcet’s disease. Methods: Retrospective study was performed on 22 eyes of 19 patients diagnosed as recurrent intermediate uveitis or Behcet’ disease. They had received a intravitreal injection of triamcinolone acetonide (4 mg/0.1 ml) and followed up at least eight months. At first week and monthly after IVTA injection, best-corrected visual acuity and intraocular pressure were measured and slit-lamp examination and indirect ophthalmoscopy was performed. Results: The mean age of the patients was 46.1 years and mean follow-up period was 11.5 months. After IVTA injection, inflammation and visual acuity improved significantly in 15 eyes (68.2%) and 16 eyes (72.7%). The dosage of oral corticosteroid decreased significantly in all patients. Intraocular pressure was increased (>21 mmHg) in 5 eyes (22.7%). One of these eyes (4.5%) received a glaucoma surgery for intractable glaucoma after IVTA injection. Inflammation recurred in 7 eyes (31.8%) and the IVTA was reinjected to them. Its effects were similar as first injection Conclusions: Although a IVTA injection effectively improved visual acuity and inflammation in most recurrent intermediate uveitis and Behcet’ disease, side effects such as the increased intraocular pressure were developed. The complication rate as well
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Abstract Book as the treatment effect should be taken into consideration when using this treatment method. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Behcet’ disease, Intermediate uveitis, Intravitreal injection, Triamcinolone acetonide.
PO2-15-04 CMV RETINITIS FOLLOWING INTRAVITREAL INJECTION OF TRIAMCINOLONE: A REPORT OF TWO CASES Delyfer Marie-Noelle (Ophthalmology Department - Bordeaux University Hospital, France) Dely fer Marie-Noelle ( O p h t h a l m o l ogy Dep a rtment - Bordeaux University Hospital, France), Rougier Marie-Benedicte (Ophthalmology Department Bordeaux University Hospital, France), Hubschman Jean-Pierre (Espace Hélios - Saint-Jean-de-Luz, France), Aouizerate Franck (Ophthalmology Department - Clinique Thiers, Bordeaux, France), Korobelnik Jean-Francois (Ophthalmology Department - Bordeaux University Hospital, France) Cytomegalovirus retinitis usually affects severely immunosuppressed individuals. However some exceptional and isolated cases of CMV retinitis have been described in immunocompetent patients. We report two cases of non-immunodeficient patients seen in our institution over a period of 6 months who presented CMV retinitis a few weeks after an intravitreal injection of triamcinolone acetonide. Even if cellular and molecular mechanisms underlying the development of CMV in an immunocompetent patient’s eye remain to be precised, the well-known immunosuppressive properties of corticosteroids suggest that triamcinolone probably plays a role in the endogenous reactivation of latent CMV. Our two patients received indeed a high dose of triamcinolone. Both had also pseudophakia, vitrectomy and past medical history of type 2 diabetes mellitus. Such features, individually or combined, may be risk factors for local reactivation of CMV and should be considered prior to the administration of triamcinolone acetonide in ophthalmology. Financial fundings: None Conflict of interest: None Keywords: Triaminolone, Cytomegalovirus, retinitis
PO2-15-05 RESULTS OF CATARACT EXTRACTION AND FILTRATION SURGERY FOLLOWING TREATMENT WITH THE FLUOCINOLONE AC E TONIDE INTRAVITREAL IMPLANT FOR POSTERIOR UVEITIS Sheppard John D (Eastern Virginia Medical School, Hampton, Virginia), the Fluocinolone Acetonide Implant Uveitis Study Group Introduction: The fluocinolone acetonide (FA) intravitreal implant e ffective ly controls infl a m m ation and decreases the need fo r adjunctive therapy in e yes with non-infectious uveitis; however, side effects include cataracts and elevated IOP. We describe the safety and efficacy of cataract extraction and filtration surgery in eyes implanted with the FA intravitreal implant. Methods: A total of 278 posterior uveitis patients were treated with the 0.59-mg or 2.1-mg FA implant in their more severely diseased eye and followed for 3 years. Outcomes analyzed herein include changes in visual acuity (VA) and adverse events among eyes that
underwent cataract extraction and/or filtration surgery. Results: By three years, 93% of phakic implanted eyes had undergone cataract ex t raction compared to 20% of fellow eye s . Implanted eyes showed greater improvement in VA (P<0.005) and less AC inflammation (P<0.01) at 1 and 3 months post-cataract extraction than non-implanted eyes. 41% of implanted eyes had filtering procedures compared to 2% of fellow eyes. Mean pre-and post surgery IOP was 33 ± 9 mm Hg and 14 ± 7 mm Hg (3 months post surgery, with similar results at 6 and 12 months post surgery all with p <0.0001), while post-op VA was similar to baseline. Finally, one year post-filtering 42% of IOP lowering surgeries were considered a success and another 42% were considered a qualified success (IOP of 6-21 mm Hg post-op without or with the use of additional meds, respectively). Conclusion: Cataract extraction and filtering surgeries in eyes implanted with the FA intravitreal implant generally produced successful outcomes that we re comparable or better than those obtained in fellow, non-implanted eyes Financial fundings: Bausch & Lomb, Inc. Conflict of interest: Dr. Sheppard receives grant support and/or consultant and/or lecture fees from Alcon, Allergan Inc., Bausch & Lomb Inc., Isis Pharmaceuticals, Lumenis, Ophthalmic Mutual Insurance Company, Santen Inc., Inspire, and Vi s t a ko n Pharmaceuticals LLC. Keywords: uveitis, fluocinolone acetonide, side effects
PO2-15-06 INTRAVITREAL BEVACIZUMAB INJECTION IN IRVAN (IDIOPATHIC RETINAL VASCULITIS, ANEURYSMS, AND NEURORETINITIS) SYNDROME Amselem Luis (Hospital General Universitario deValencia) DiazLlopis Manuel (Hospital General Universitario deValencia), Salom D avid (Hospital General Unive rs i t a rio deValencia), Montero Javier (Hospital General Universitario deValencia), Palomares Paula (Hospital General Universitario deValencia), Hernandez L Maria (Hospital General Universitario deValencia) Introduction and objectives: To determine whether intravitreal bevacizumab may improve anatomical and visual outcomes in a patient with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome. Methods: Setting: Clinical practice. Patient: A 41-year-old man with IRVAN presenting with blurred vision and metamorphopsia, severe macular edema, retinal aneurysms, neuroretinitis, vasculitis and peripheral capillary nonperfusion previously treated with argon laser photocoagulation in the right eye. Best corrected visual acuity (BCVA) was 20/80. Systemic investigations were uniformly noncontributory. Intervention: Intravitreal injection of bevacizumab (1.25 mg) in the right eye. Main Outcome Measures: Postinjection best corrected visual acuity (BCVA), angiographic findings, optical coherence tomography (OCT) findings and complications. Results: Two weeks after treatment, the patient demonstrated improvement of the macular edema, with an increase in BCVA from 20/80 to 20/30. After 3 months, macular thickness in the OCT and vision remain stable with no significant adverse events. Conclusions: Intravitreal bevacizumab may be useful for the treatment of eyes with macular edema secondary to IRVAN syndrome. Financial fundings: None Conflict of interest: None Keywords: IRVAN, bevacizumab, macular edema
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Abstract Book PO2-15-07 A NEW T E C H N I QUE FOR POSTERIOR SUBTENON INJECTION OF CORTICOSTEROIDS USING POLYTETRAFLUOROETHYLENE INTRAVENOUS CANNULA ABBAS ZAHIR (DR. R. P. CENTRE FOR OPHTHALMIC SCI ENCES, AIIMS) KUMAR SHEKHAR CHANDRA (DR. R. P. CEN TRE FOR OPHTHALMIC SCIENCES, AIIMS), VENKATESH PRADEEP (DR. R. P. CENTRE FOR OPHTHALMIC SCIENCES, AIIMS), GARG SAT PAUL (DR. R. P. CENTRE FOR OPH THALMIC SCIENCES, AIIMS) Posterior subtenon (PST) injection of corticosteroids is a well established treatment modality of macular edema from various disorders like diabetes, uveitis, vascular occlusions and post-surgery. Smith and Nozik method is a standard technique of injecting corticosteroids into the posterior subtenon space. However it has a potential to cause globe perforation since the sharp needle has to be introduced blindly right upto the hub. We show a video demonstrating the injection of corticosteroids into the deep posterior subtenon space using a 22 gauge polytetrafluoroethylene (PTFE) intravenous cannula. The method is equally effective and safer than the Smith and Nozik technique. Financial fundings: NONE Conflict of interest: NONE Keywords: CANNULA METHOD , POSTERIOR SUBTENON, CORTICOSTEROID
PO2-15-08 BEVACIZUMAB FOR REFRACTORY POST-OPERATIVE CYSTOID MACULAR EDEMA Tordilla-Wadia Jennifer Grace (University of Toronto Department of Ophthalmology and Visual Sciences), Lam Wai-Ching (University of Toronto Department of Ophthalmology and Visual Sciences) Introduction: Cystoid macular edema can be a chronic problem despite tre atment with non-steroidal or steroid medication. Vascular endothelial growth factor (VEGF) is an angiogenic stimulus, as well as a potent permeability factor implicated in cystoid macular edema. The intravitreal anti-VEGF agent, bevacizumab, has been shown to reduce macular edema from vascular disease such as diabetes and vascular occlusion, as well as exudative age related macular degeneration. Its role for treating macular edema from non-vascular causes is not well known. This study investigates the use of intravitreal bevacizumab for refractory post-operative cystoid macular edema. Methods: A retrospective chart review of patients with recalcitrant cystoid macular edema who received intravitreal bevacizumab was performed. The patients must not have had any coexisting retinal vascular disease or exudative macular degeneration. Anatomical and visual acuity responses to intravitreal bevacizumab were recorded. Results: Two patients received intravitreal bevacizumab for postoperative cystoid macular edema. Patient one had macular edema after vitrectomy and membrane peeling surgery for an epiretinal membra n e. Foveal thickness measured by optical coherence tomography reduced from 463 to 342 microns after a single injection of intravitreal bevacizumab. Visual acuity remained stable with a significant cataract. Patient two had cystoid macular edema after glaucoma surgery with placement of an Ahmed valve. Steroid treatment was con-
traindicated because of his glaucoma history. After receiving 3 intravitreal bevacizumab injections, foveal thickness reduced from 484 to 443. There was also an improvement in visual acuity. Conclusion: Intravitreal anti-VEGF agents may be an effective adjunctive therapy for treating refractory post-operative CME, especially in patients who are steroid responders. Its long-term efficacy needs to be investigated further in a randomized, prospective study. Financial fundings: None Conflict of interest: None Keywords: Bevacizumab, surgery, macular edema
PO2-15-09 RETINAL NECROSIS POST INTRAVITREAL INJECTION OF AUTOLOGOUS PLASMIN ENZYME Diaz-Llopis Manuel (Hospital General Valencia) Udaondo Patricia (Hospital General Valencia), Salom David (Hospital Genera l Valencia), Cervera Enrique (Hospital General Valencia), GarciaDelpech Salvador (Hospital General Valencia) Garcia-Pous Maria (Hospital General Valencia) Introduction and Purpose: It has been reported that intravitreal injection of autologous plasmin enzyme (APE) 24 to 36 hours before vitrectomy is effective in the successful treatment of macular holes and diabetic retinopathy. Acute retinal necrosis has not been reported to be associated with intravitreal injection of APE. Methods: We report a case of acute retinal necrosis 24 hours after intravitreal injection of APE and before vitrectomy had been performed to treat his diabetic retinopathy. Results: A 64 year-old-man presented with acute loss of vision and pain 24 hours after intravitreal injection of APE (plasmin was activated with stre ptokinase as reported by Jonathan G et al in Ophthalmology 2001). Visual acuity was counting fingers on his left eye; on slit-lamp examination there were 2-plus cell in the anterior chamber and vitreous. Fundus examination showed a wide area of retinal necrosis with multiple cotton-wool spots and haemorrhages. We decided to administrated topical treatment based on corticoids, antibiotic and midriatic before vitrectomy. The final VA was light perception, Conclusions: Due to the signs and symptoms appear 24 hours after the intravitreal injection we must think that the retinal necrosis was secondary to the APE injection, and perhaps streptokinase used to activate the plasmin was directly involved in this fatal effect. As far as we know this is the first case of retinal necrosis describe after APE injection for pharmacologic vitreolysis. Financial fundings: No finantial interest Conflict of interest: No conflict of interest Keywords: retinal necrosis, autologous plamin enzyme, vitreolysis, diabetic retinopathy.
PO2-15-10 LACK OF BEVACIZUMAB EFFICACY IN THE TREATMENT OF UVEITIS AND ITS COMPLICATIONS Barros Ana Carolina M (Unifesp) Cristina Muccioli (Unifesp), Belfort Jr N Rubens (Unifesp) Purpose: To describe functional and anatomical findings after intravitreal injection of Bevacizumab in patients with complications secondary to uveitis.
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Abstract Book Design: Case series Methods: Eight patients diagnosed as having uveitis from diferent aetiologies as well as their complications, such as cystoid macular edema, vasculitis and retinal exsudation. Patients received a single intravitreal injection of 1.25 mg of Bevacizumab. Medical records describing ophthalmologic evaluations were reviewed for each patient. Optical coherence tomography was performed in patients with cystoid macular edema, before and after injection. Results: Patients age ranged from 16 to 48 years. The aetiology of uveitis comprised: toxoplasmosis, tuberculosis, anterior uveitis secundary to espondilitis, granulomatous idiopatic uveitis, eritematous lupus and Coat´s like disease, and Behçet´s disease. Four patients developed cystoid macular edema, 4 presented with vasculitis and 1 with a sub retinal exsudation. The OCT disclosed an improvement of retinal thickness in 3 patients with macular edema. Vasculitis improved in all patients; and subretinal exsudation presented without improvement. The time of relapsing was 3,3 weeks, (2 to 5 weeks). Conclusion: Intravitreous Bevacizumab injection seems to have limited action for the treatment of uveitis and its complications. Randomized clinical trails will be necessary to determine its efficacy.
Meier analysis revealed that 57% of patients experienced a VA improvement of 2 lines; CMT was reduced by 50 or more microns at the 1 year endpoint in 55% of the patients. Linear regression analysis, verifying the correlation between the improvement in CMT and VA, yielded a Pearson’s coefficient of 0.158. No significant complications requiring modification of the patient’s current treatment regimen ocurred. Conclusions: Intravitreal bevacizumab appears to be a useful agent in the long-term control of recalcitrant uveitic macular edema. Additional multi-centered, randomized clinical trials comparing IVB with standard therapy should be encouraged.
Financial fundings: (None.) Conflict of interest: (None.) Keywords: AVASTIN, UVEITIS, COMPLICATIONS
Introduction and Objective: To present 16 cases of Ocular Histoplasmosis-like syndrome in a nonendemic area with negative antibody serology test to Histoplasmosis Methods: This is a Institutional prospective study of 15 eyes from 8 immunocompetent patients. all patients had ocular clinical features that resembled the POHS.All patients had negative antibody serum test to Histoplasmosis and negative medical and laboratorial evaluation to Toxoplasomosis, Syphilis and Tuberculosis. Results: Five patients presented with the classical triad of ocular clinical features that include peripapillary scarring, Histo spots and Choroidal neovascularization. One patient had an enlargement of an atrophic chorioretinal scar.One patient had multiple RPE detachment. One had a neovascularized REP detachment and one had only histo spots. Conclusions: Sixteen eyes from eight patients presented similar findings observed in ocular Histoplasmosis syndrome. Th e s e patients had no signs of systemic or laboratorial Histoplasmosis or others diseases that resembled ocular Histoplasmosis. We belive that the findings in the eyes of these patients were not due Histoplasma capsulatum infection and that therefore other agents could cause a similar clinical picture as an atypical mycobacteria or the mycobacterium avium intracellulare as cited in the literature.
PO2-15-11 LONG-TERM OUTCOMES OF INTRAVITREAL BEVACIZUMAB IN PATIENTS WITH REFRACTORY UVEITIC MACULAR EDEMA Quinones Karina (Massachusetts Eye Research and Surgery Institute), Cervantes-Castañeda A Rene (Massachusetts Eye Research and Surgery Institute), Yilmaz Taygan (Massachusetts Eye Research and Surgery Institute),MacDonell Rebecca (Center for the Evaluative Clinical Sciences at Dartmouth), Foster C. Stephen (Massachusetts Eye Research and Surgery Institute) Purpose: To evaluate long-term outcomes of intravitreal bevacizumab (IVB) injection in patients with refractory uveitic macular edema (UME). Methods: Retrospective, interventional case series of all patients from our Institute with controlled uveitis that received IVB with at least 6 months of follow-up. Loss of vision in UME was related to optical coherence tomograp hy (OCT)-proven macular edema despite standard therapy. Topical and systemic medications employed in the treatment of UME were not altered during the study. Results: Twenty-seven patients (29 eyes), including 19 females, with mean age of 57 years ± 17.32 (range: 18-85) were followed for 12 months. Diagnosis included idiopathic uveitis (48%), sarcoidosis associated uveitis (15%), acute retinal necrosis (11%), and birdshot choroidoretinopathy (7%). Most cases presented with panuveitis (n=13), followed by posterior (n=7), anterior (n=6), and intermediate (n=1) uveitis. All patients except one were controlled with at least one immunomodulating agent at the time of their first injection. Six eyes (21%) required an additional IVB and 10 eyes (34%) required a combination of IVB and intravitreal triamcinolone. After 1 year, there was a statistically significant difference in average VA and central macular thickness (CMT) compared to baseline with p-values of 0.0045 and 0.0007, respectively. Kaplan-
Financial fundings: None Conflict of interest: No potential conflict of interests. Keywords: macular edema, intravitreal bevacizumab, uveitis
PO2-23-02 OCULAR HISTOPLASMOSIS-LIKE SYNDROME IN A NONENDEMIC AREA Muccioli Cristina (Federal University of Sao Paulo, Brazil), Amaro H Miguel (Federal University of Sao Paulo, Brazil), Abreu T Mariza (Federal University of Sao Paulo, Brazil)
Financial fundings: (None.) Conflict of interest: (None.) Keywords: Histoplasmosis,choroiditis,Histoplasma capsulatum
PO2-23-03 UVEITIS MASQUERADE SYNDROMES Svozilkova Petra (Department of Ophthalmology, 1st Faculty of M e d i c i n e, Charles Unive rs i t y, Prag u e, Cze ch Republic) Heissigerova Jarmila (Department of Ophthalmology, 1st Faculty of Medicine, Charles Unive rs i t y, Prag u e, Cze ch Republic), Brichova Michaela (Department of Ophthalmology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic), Jenickova Dagmar (Department of Ophthalmology, 1st Faculty of Medicine, Charles Unive rs i t y, Prag u e, Cze ch Republic), S a ch Jo s e f (Department of Pat h o l ogy, 3rd Faculty of Medicine, Charles
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Abstract Book University, Prag u e, C ze ch ) , Rihova Eva (Dep a rtment of O p h t h a l m o l ogy, 1st Faculty of Medicine, C h a rles Unive rs i t y, Prague, Czech Republic) Introduction and objectives: The uveitis masquerade syndromes (UMS) are a group of non-inflammatory ocular diseases of benign or malign origin that mimic intraocular inflammation. Because UMS are not only sight-threatening but in case of malign UMS also life-threatening diseases is prompt correct diagnosis and treatment very important. The aim of this study is to evaluate the frequency, clinical features and diagnostic tests of UMS. Methods: A retrospective study of 79 patients treated for UMS at the Department of Ophthalmology, 1st Faculty of Medicine in Prague, between 1996 and 2006, was performed. Results: Seventy-nine patients with UMS (7.1%) from all 1112 p atients with uveitis we re included. Malign UMS we re recog n i zed in 37 patients (18 males and 19 females, mean age 55 ye a rs) and benign UMS in 42 patients (19 males and 23 females, mean age 33.7 years). The most frequent cause of malign diseases was non-Hodgkin's lymphoma (n=19), wh i ch manifests mainly as panu veitis. Other malign UMS involved leukemia and other hemat o l ogic malignancies (n=9), metastasis (n=3), ch o roidal melanoma (n=1), retinoblastoma (n=1) and paraneoplastic syndrome (n=4). The most frequent cause of benign UMS was a group of vascular anomalies (n=22), wh i ch pre sent mainly as posterior uveitis. Clinical fe at u res of uveitis we re observed in other benign diseases: S ch wa rtz syndrome (n=5), retinal dy s t rophies (n=3), d rug-induced uveitis (n=4), fo reign intraocular body (n=1), pigment dispersion syndrome (n=2), ocular isch e m i c s y n d rome (n=1), ch o roidal osteoma (n=3) and juvenile xanthogra nuloma (n=1). The most valuable diagnostic procedures we re intra o c ular fluid analysis and fl u o rescein angi ograp hy; in indicated cases also ultrasonograp hy, m agnetic resonance, immunophenotyping of cereb rospinal fluid and bone marrow. Conclusions: UMS should be considered in all patients with idiopathic corticosteroid resistant chronic uveitis. The investigation of patients aged 40 years and older should be focused on possible diagnosis of non-Hodgkin's lymphoma. Timely treatment may improve the prognosis of UMS. Financial fundings: (None.) Conflict of interest: (None.) Keywords: uveitis masquerade syndromes, non-Hodgkin's lymphoma, vascular anomalies
PO2-23-04 CLINICAL FEATURES OF OCULAR TOXOPLASMOSIS IN COLOMBIA de-la-Torre Alejandra (Centro de Investigaciones Biomedicas, U n ive rsidad del Quindio) Lopez-Castillo Cristian (Centro de Inve s t i gaciones Biomedicas, U n iversidad del Quindio),GomezMarin E Jo rge (Centro de Investigaciones Biomedicas, Universidad del Quindio) Purpose: to evaluate the clinical features, treatment and recurrences of patients with ocular toxoplasmosis in a referral center for toxoplasmosis. Methods: We reviewed retrospectively the clinical records of patients with diagnosis of ocular toxoplasmosis that were attended in a specialized consult in toxoplasmosis in Quindio?s university health center in Armenia (Colombia), between September of 2005 to November of 2006 (14 months). Results: 66 patients were found with diagnosis of ocular toxoplasmosis, 44 patients were included (59 affected eyes). 20 male
(45.5%) and 24 female (54.5%), with a median age in the first episode of 24 years (P25 10 ? P75 33). 20 cases had active lesion (45.5%). Bilateral involvement was found in 17 cases (38.6%). 8 inactive cases (33.3%) had legal blindness (VA <20/200). The most frequent complications were: posterior sinequiae (n: 9; 20.5%), strabismus (n: 8; 18.2%), ocular hypertension 4 (9.1%); cataracts 3 (6.8%), cystoid macular edema 3 (6.8%) and choroidal neovascularization 1 (2.3%). We found that 2 cases (11.8%) of the recurrent lesions displayed IgM positive. Conclusions: This is the first report about clinical features of patients with ocular toxoplasmosis in Colombia. This entity causes blindness and visual impairment, affecting mainly young people. Ocular toxoplasmosis frequently affected the macula We recommend creating primary prevention programs for the general people in our country. Financial fundings: Universidad del Quindio Conflict of interest: None declared Keywords: Ocular toxoplasmosis, clinical, Colombia
PO2-23-05 P30 PEPTIDES RECOGNITION PATTERN BY PATIENTS WITH OCULAR TOXOPLASMOSIS Gomez-Marin Jorge E (Centro de Investigaciones Biomedicas, Universidad del), de-la-Torre Alejandra (Centro de Investigaciones Biomedicas, Universidad del Quindio) C a rdona Nestor (Centro de Investigaciones Biomedicas, Universidad del Quindio), Siachoque Heber (Universidad del Rosario, Bogota) Purpose: The P30 is the major antigenic protein of Toxoplasma gondii. Immune response in animal models has showed that recognition by antibodies preferentially occurs at the carboxy end peptides of the protein. Recognition pattern of peptides by human serum antibodies is unknown. We aimed to determine what peptides from the P30 protein were recognised by human infected with Toxoplasma Methods: We performed an immunoenzymatic assay with serum from patients with different clinical forms. We use 9 peptides from the amino and the carboxy end derived from the P30 protein of Toxoplasma gondii. Results: Initial assays with serum from congenital, ocular and chronic asymptomatic toxoplasmosis indicated that they only recognized the peptides from the carboxy end of the protein and that serum from patients with ocular toxoplasmosis gets a higher absorbance against the peptide Pep17 compared to the other serum with congenital or chronic asymptomatic infection. We then tested the peptide Pep17 in 32 patients with toxoplasmosis; 13 without ocular infection, 13 with inactive chorioretinal scars and 6 with active ocular infection. All serum recognized this peptide and there were not differences in the absorbencies levels between groups. Conclusions: As occurs in mice the human serum antibodies are addressed against the carboxy terminal peptides of P30 major protein. We are currently working on to the cellular immune response against the same peptides in order to determine if there is dichotomy between humoral and cellular immune response during the ocular infection of human toxoplasmosis. Financial fundings: Universidad del Quindio Conflict of interest: None declared Keywords: Ocular toxoplasmosis, P30, peptides
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Abstract Book PO2-23-06 DEHYDRO E P I A N D ROSTENIONE SULPHATE (DHEAS) LEVELS IN OCULAR TOXOPLASMOSIS de-la-Torre Alejandra (Centro de Investigaciones Biomedicas, Universidad del Quindio) Cardozo-Garcia M Carlos (Centro de Inve s t i gaciones Biomedicas, U n ive rsidad del Quindio), RiosCadavid C A n gela (Centro de Investigaciones Biomedicas, Universidad del Quindio), Gomez-Marin E Jorge (Centro de Investigaciones Biomedicas, Universidad del Quindio) Introduction and objectives: Reduction of the levels of dehydorepiandrostenione sulphated hormone (DHEAS) has been related with increased susceptibility to Schistosoma and Plasmodium infection; there are not previous studies during ocular toxoplasmosis. The objective of this study was to determine if there are any differences in the DHEAS levels during different clinical stages of ocular toxoplasmosis. Methods: We use the chemoluminiscence automatized Immulite assay to determine the levels of DHEAS. Four groups of individuals were studied: i) Individuals with chronic asymptomatic infection with a positive test for IgG anti-Toxoplasma and without ocular lesions (n: 16); ii) Chronic asymptomatic patients with retinal scars of retinochoroiditis by Toxoplasma (n:16); iii) Acute symptomatic patients with active retinopchoroiditis by Toxoplasma (n:26); iv) Individuals with negative assays for specific IgG antiToxoplasma (n:14). Comparison of DHEAS levels between groups were adjusted by age and sex and non-parametric Kruskall Wallis statistical tests were applied, to determine differences in the median of DHEAS levels. Results: We found significant lower levels in patients with active ocular toxoplasmosis compared to patients without active lesions (p=0.022). Interestingly, there were also significant differences between the infected group without ocular lesions and the non infected group of individuals (p=0.022). Conclusions: Our results suggest that DHEAS levels could be reduced during active ocular toxoplasmosis, further studies to clarify his role during Toxoplasma infection is warranted. Financial fundings: Universidad del Quindio Conflict of interest: None declared Keywords: DHEAS, ocular toxoplasmosis, hormones
PO2-23-07 ELEVATED PLASMA LEVELS OF NERVE GROWTH FACTOR IN PATIENTS WITH INTERMEDIATE UVEITIS Karaliute Zydrune (Dep a rtment of Ophthalmology, Vilnius University Hospital "Santari ki˜ Klinikos", Lithuania) Wojciak Anna (Dep a rtment of Ophthalmology, Medical Academy of Gdansk, Poland), Torun Necip (Clinic of Ophthalmology, Charite, University School of Medicine Berlin, Campus Virchow Klinikum, Germany) Pleyer Uwe (Clinic of Ophthalmology, Charite, University School of Medicine Berlin, Campus Virchow Klinikum, Germany) Introduction and objectives: Nerve growth factor (NGF) serum levels have been shown to be increased in certain autoimmune and inflammatory diseases. It is assumed, that in addition to its neurotrophic action, NGF is an important regulatory factor in different inflammatory and immune processes. Since autoimmune mechanisms are considered in the pathogenesis of intermediate uveitis, we evaluated systemic concentrations of NGF in affected patients and compared them with healthy controls. Methods: 26 consecutive patients (17-56 years old) with active
intermediate uveitis without systemic immunosuppressive treatment at the time of analysis were included. None of these individuals had evidence of an underlying disease; in particular multiple sclerosis and sarcoidosis were excluded. As controls served 11 age and sex matched healthy volunteers. Plasma NGF concentrations were determined by a sandwich enzyme linked immunosorbent assay. The Mann-Whitney U test was used for data analysis. Results: Significantly higher NGF levels were detected in patients with intermediate uveitis (44.42 ± 5.97 pg/ml), compared with agematched healthy controls (20.91 ± 2.63 pg/ml) (p<0.003). Conclusions: The present study demonstrated for the first time a significant increase of the NGF level in intermediate uveitis patients and may indicate an involvement of NGF in the pathogenesis of this disease. Financial fundings: Supported in part by Charite grant (Pl 2006). Conflict of interest: The authors declare no conflict of interests. Key wo rd s : I n t e rm e d i ate uve i t i s , Nerve growth factor, Autoimmunity
PO2-23-08 TOXOPLASMA RETINOCHOROIDITIS ASSOCIATED WITH ATOVAQUONE RESISTANCE Dahr Sam S (Retina Center of Oklahoma) O b j e c t ive: To describe a clinical case of tox o p l a s m a retinochoroiditis resistant to atovaquone therapy. Methods: Case Report. Results: A 34 year old woman with a history of previous toxoplasma retinochoroiditis in her right eye presented with a flare up of inflammation. She had experienced two prior episodes over the past five years and each episode was allowed to subside without therapy other than topical steroids. Given the significant vitreous inflammation, systemic therapy was recommended. The patient chose atovaquone therapy over sulfadiazine and pyrmethamine in the hopes of achieving a cysticidal effect and decreasing the chance of recurrence. Systemic atovaquone therapy was initiated and two days later systemic prednisone was added. Five days after starting prednisone therapy, the patient was re-assessed and found to have dramatically increased vitritis as well as an expanded area of retinochoroiditis. Atovaquone was discontinued and the patient was placed on sulfadiazine and pyrimethamine with good subsequent response. Conclusions: Patients placed on atovaquone as the sole anti-toxoplasma therapy should be monitored closely, especially while on prednisone, as their inflammation may worsen,suggesting an atovoquone-resistant toxoplasma organism. Financial fundings: None Conflict of interest: None Keywords: toxoplasma, atovaquone, resistance
PO2-23-09 HLA-DR15: A RISK FACTOR FOR INTERMEDIATE UVEITIS IN PATIENTS WITHOUT MULTIPLE SCLEROSIS Thomas D. (Department of Ophthalmology, St Thomas´Hospital, London, U.K.) Barathan V. (Guys, King´s College and St Thomas´Hospital Medical and Dental Sch o o l ) , Ko n d e atis E. ( D ep a rtment of Tissue Typing,Guys, King´s College and St Thomas´Hospital Medical and Dental School), Vaughan R. W.
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Abstract Book (Department of Tissue Typing,Guys, King´s College and St Thomas´Hospital Medical and Dental School) Graham E. M. (Dep a rtment of Ophthalmology, St Thomas´Hospital, London, U.K.) Stanford M. R. (Dep a rtment of Ophthalmology, St Thomas´Hospital, London, U.K.) Introduction and objectives: Several recently published studies have suggested that intermediate uveitis may belong to a constellation of HLA-DR15 related disorders.The objective of this study was to evaluate the association between human leukocyte antigen (HLA-DR15) and intermediate uveitis in patients without Multiple Sclerosis (MS). Methods: Sixty seven patients diagnosed with intermediate uveitis underwent HLA-DR15 serotyping and were compared with a nonuveitic control group (n=300). The patients were derived from both secondary and tertiary referral centres to reduce selection bias. Any patient known to have MS or who developed MS in the 5-year follow up period was excluded. The relative risk 1) for developing intermediate uveitis and 2) for poor visual outcome in patients with intermediate uveitis who were HLA-DR15 positive was calculated. Good visual outcome was defined as better than or equal to 6/12 Snellen at 5-year follow up and poor vision was defined as less than 6/12. Results: 33/67 (49%) of the patients with intermediate uveitis were positive for HLA-DR15 compared with 90/300 (30%) of subjects in the control group. The frequency of the HLA-DR15 in patients with intermediate uveitis was higher than in the control subjects (relative risk = 1.63, 95% Confidence Interval: 1.22 – 2.19, P=0.05). Patients with intermediate uveitis who were HLA-DR15 positive had a lower risk of poor visual outcome at 5-year follow up (relative risk = 0.88, 95% Confidence Interval: 0.64 – 1.20, P=0.05) compared to patients with intermediate uveitis who were HLADR15 negative. Conclusions: This study suggests that HLA-DR15 confers an increased risk for developing intermediate uveitis, independent of an association with MS. However, patients with intermediate uveitis who are HLA-DR15 positive are more likely to achieve a good visual outcome at 5-year follow up. Financial fundings: The Iris Fund for the prevention of Blindness and The TFC Frost Charitable Trust Conflict of interest: None Keywords: HLA-DR15, Intermediate uveitis,relative risk
PO2-23-10 TREATMENT OF ACUTE SERPIGINOUS CHOROIDITIS WITH HIGH-DOSE INTRAVENOUS CORTICOSTEROIDS Ness Thomas (Universitäts-Augenklinik Freiburg, Germany) Introduction and objectives: Serpiginous choroiditis is a potentially blinding disease. Despite of systemic immunosupressive therapy many patients experience acute deterioration of visual acuity and visual field. We describe a rescue therapy in the case of acute serpiginous choroiditis. Methods: Retrospective review of the records of three patients with serpiginous choroiditis, who were treated with high dose corticosteroid pulse. The improvement of visual acuity was evaluated. Results: Three episodes of acute deterioration of visual acuity in three patients were treated. Two of them suffered from a recurrence of inflammation, while one suffered from subretinal neovascularization. All patients received 500 mg prednisolon acetat intra-
venously for three days. Systemic immunosuppressive therapy was c o n t i nu e d. The fi rst two patients with infl a m m at o ry disease responsed immediately to the treatment, while the patient with the neovascularisation failed. Conclusions: In the case of acute serpiginous choroiditis due to inflammation high dose pulse of corticosteroids is effective in recovering of the visual function in a very short time. Financial fundings: none Conflict of interest: none Keywords: serpiginous choroiditis, corticosteroids, acute deterioration
PO2-23-11 REACTIVATION OR RE-INFECTION ON TOXOPLASMOSIS Muccioli Cristina (Federal University of Sao Paulo) Silveira Claudio (Federal University of Sao Paulo ), Belfort Jr Rubens (Federal University of Sao Paulo) Valochi, Adriana (University of Sao Paulo), Rizzo Luis (University of Sao Paulo) Purpose: To present a serie of cases of ocular and systemic toxoplasmosis whose patients presenteds with persistent positive serology IgG and IgM for toxoplasmosis and positive PCR for toxoplasmosis in peripheral blood. Design/methods: Were analyzed 120 healthy patients from Clinica Silveira, Erechim, HIV negative and presenting IgG and IgM circulating antibodies against Toxoplasma gondii. These patients had serological accompaniment from 1 to 5 years. Ten patients were analyzed for PCR. Setting/results: Of the 120 patients with positive IgM with accompaniment by more than 1 year: • 72 patients had the negative exam again and they maintained this result • 21 patients decreased the title to levels limits between positive and negative (border line) • 18 patients maintained high titles by more than 1 year (1 to 5 years) • 9 patients firstly positive for IgM had a negative exam and change to positive again Six patient presented PCR positive. Conclusion: These cases suggest that the toxoplasmosis can stay in latent state and to reactivate years after, besides with positive IgM in high levels, concomitant with ocular recurrences or re-emergence of systemic symptoms of the disease. The presence of T. gondii in the peripheral blood in some patients of these groups could be associate to the reactivation or re-infection. PCR confirms that T. gondii can be present in the peripheral blood months or years after the initial infection. Financial fundings: NONE Conflict of interest: NONE Keywords: Toxoplasma, re-infection, reactivation
PO2-23-12 MULTIFOCAL ELECTRORETINOGRAPHY FOR THE FUNCTIONAL STUDY OF UVEITIS Salom David (Hospital General Valencia), Diaz-llopis Manuel (Hospital General Valencia) Udaondo Patricia (Hospital General Valencia), Garcia-Pous Maria (Fundacion Oftalmológica del
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Abstract Book Mediterraneo) Hern a n d e z - G a r fella Marisa (Hospital Genera l Valencia) del Amo Victoria (Hospital General Valencia) Introduction and Purpose: Because there are some cases where patients consult at the end of an inflammatory process and then it is very difficult to evaluate the visual abnormalities they have, the objective of this paper is to determine the usefulness of mERG in the diagnosis and follow-up of posterior uveitis. Methods: We report two cases of uveitis with posterior pole involvement where the mERG demonstrated its utility in the evolution of these patients. Results: The first case is a 22 year old man with an inespecific visual abnormality diagnosed of a Dengue-related maculopathy after the finding of a decreased macular response in the mERG; the second case is a 12 year-old child with an important metamorphopsia and loss of vision secondary to acute multifocal posterior placoid epiteliopathy not corresponding to the good tre at m e n t response and the retinal image; in this case the mERG demonstrated an important deterioration of the retinal function. Conclusions: The mERG is an useful technique for the diagnosis and monitorization of patients with retinal involvement due to uveitis. It is able to confirm a retinal dysfunction when the ophthalmologic examination is normal or there is no correspondence between the signs and symptoms. Financial fundings: No financial interest Conflict of interest: No conflict of interest Keywords: multifocal electrorretinography, uveitis, posterior pole, Dengue
PO2-23-13 F ROSTED BRANCH ANGIITIS: CASE REPORT AND REVIEW OF THE LITERATURE Derzko-Dzulynsky Larissa A (University of Toronto), Lee Kevin (University of Toronto), Kertes J Peter (University of Toronto) Introduction and objectives: Frosted branch angiitis may represent a common presentation to various etiologic agents and may vary in severity, rates of complications, and final anatomic and visual outcomes. Primary or idiopathic frosted branch angiitis occurs in children and young adults and is characterized by a bilateral diffuse retinal perivascular sheathing with a transclucent retinal appearance and associated uveitis. Methods: A case of a 42 year old man with presumed frosted branch angiitis will be presented and the literature reviewed. Results: We present a case of a healthy 42 year old male with primary frosted bilateral branch angiitis with atypical features of retinal neovascularization, vitreous hemorrhage and tractional retinal detachment and visual decrease to counting fingers bilaterally. All investigations for infectious and inflammatory etiologies were negative. He was treated initially with high dose oral prednisone with minimal improvement in visual acuity and eventually underwent pars plana vitrectomy, membrane peel, endolaser, air fluid exchange, intravitreal triamcinolone and SF6 gas. The vision improved significantly after surgical intervention. Most recent visual acuities were 20/30 OD and 20/40 OS. There have been 60 cases of frosted branch angiitis reported in the literature since first described by Ito in 1976. Most cases are bilateral, are treated with systemic steroids and achieve good visual acuity outcomes. Retinal neovascularization occurs in 12%, vitreous hemorrhage in 4% and retinal detachment in 17% of cases.
Conclusions: The course of frosted branch angiitis is not always benign and may lead to severe visual loss and may require surgical intervention in addition to steroid treatment. Financial fundings: (None.) Conflict of interest: (None.) Keywords: vasculitis, neovascularization, surgery
PO2-23-14 LINEAR PATTERN OF WEST NILE VIRUS-ASSOCIATED CHORIORETINITIS IS RELATED TO RETINAL NERVE FIBRES ORGANIZATION. Jenzeri Salah (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Tritar Zohra (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Oueld El Hassen Mohamed (Fattouma B o u rguiba University Hospital, Monastir, Tunisia), Bettaieb Abdelbasset (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Messaoud Riadh (Fattouma Bourguiba Unive rs i t y Hospital, Monastir, Tunisia), K h a i rallah Moncef (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Introduction and objectives: To clarify the reason for the linear pattern of West Nile virus (WNV)-associated chorioretinitis. Methods: The study included 12 patients (24 eyes) with WNVassociated chorioretinitis. All the patients underwent a complete ophthalmic evaluation, including dilated fundus examination, fundus photography, fluorescein angiography, and indocyanine green angiography. Characteristics of linear streaks, particularly their relationship to the course of retinal and choroidal vessels, and pattern of retinal nerve fibres, were analysed. Results: All patients had bilateral multifocal chorioretinitis with linear clustering of chorioretinal lesions associated with a variable number of scattered lesions. Linear streaks, variable in number and length, originated from the optic disc or its vicinity in most cases. Their course in all cases appeared to closely follow the course of retinal nerve fibres, rather than that of retinal or choroidal vessels. Conclusions: Results of our study show that the linear pattern of WNV-associated chorioretinitis is related to retinal nerve fibres organization, suggesting a contiguous spread of WNV virus from central nerve system via the optic nerve fibres to the outer retina, retinal pigment epithelium, and choroid. Financial fundings: (None.) Conflict of interest: (None.) Keywords: West Nile Virus, Chorioretinitis, Nerve fibers
PO2-23-15 A CASE OF SYMPATHETIC OPHTHALMIA PRESENTING 15 YEARS AFTER RETINAL DETACHMENT SURGERY KAVUNCU Sevim (Ulucanlar Eye Hospital, Ankara), Ozdal Çakar P›nar (Ulucanlar State Eye Hospital, Ankara), Taflk›ntuna ‹brahim (Ulucanlar Eye Hospital, Ankara), Koklu Gultekin (Ulucanlar Eye Hospital, Ankara) Introduction and objectives: The incidence of sympathetic ophthalmia(SO) after intraocular surgery is rare. The aim of this report is to emphasize that even 15 years after, an intraocular surgery may be an inciting event for an quite and healthy eye. Methods: We report a unique case of a 49 year-old otherwise healthy man who had an detachement surgery in the right eye 15 years ago. He presented with blurred vision in the left eye and
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Abstract Book hyperemia in both eyes. He did not mention any symptoms in both eyes before. Results: Clinical examination at presentation revealed moderate bilateral non-granulamatous uveitis which was worse in the right eye. Visual acuity was hand motion in the right eye and 0.4 in the left eye. Dilated fundus examination revealed mild vitritis in the left eye and severe vitritis in the right eye. B scan ultrasonography of the right eye revealed attached retina and membrane formation in the retina. There was no Dalen-Fuchs nodule in the left eye. A presumptive diagnosis of sympathetic ophthalmia was made. The patient was started 1mg/kg oral prednisolone daily. Two weeks later, visual acuity improved to 0.9 in the left and hand motion in the right eye. The anterior chamber was quite in both eyes.The vitritis was mild in the left and moderate in the right eye. The steroid dosage tapered in the next visit. Two weeks later patient has a complaint of blurred vision in left eye. Examination revealed mild tindal and vitritis in both eyes. Oral prednisolone dosage wa s increased to 30mg/day. Conclusion: Vitreoretinal surgery has become one of the major risk factors for the devolopement of sympathetic ophthalmia. SO typically develops within 12 months of the most recent surgery. To our knowledge, the interval between detachment surgery and SO developement, is the longest ever cited in the litterature Financial fundings: This research was not funded by any source. Conflict of interest: There is no potential conflict of interest in the material used in this study Key wo rds: S y m p atethic ophthalmia, d e t a chment surge ry, l at e onset.
eyes [7.8%]), marked diffuse retinal arterial sheathing (2 eyes [3.1%]), retinal vascular leakage (5 eyes [7.8%]), optic disc swelling (4 eyes [6.2%]), optic disc staining (6 eyes [9.4%]), segmental zones of retinal pigment epithelium ch a n ges (3 eye s [4.7%]), and nonproliferat ive diabetic re t i n o p at hy (33 eye s [40.2%]). The posterior segment findings related to WNV disease had a self-limited course in all patients. Conclusions: Chorioretinal involvement, frequently asymptomatic and self-limited, is common in patients with acute WNV infection. The unique pattern of multifocal chorioretinitis in patients with systemic symptoms suggestive of WNV can help to establish the diagnosis while serologic testing is pending. Therefore, a systematic ocular evaluation, including dilated fundus examination and fluorescein angiography in selected cases, is recommended in patients with clinically suspected WNV infection. Financial fundings: None Conflict of interest: None Keywords: West Nile Virus, Chorioretinitis, Angiography
PO2-23-17 BRANCH RETINAL ARTERY OCCLUSION ASSOCIATED WITH INFECTIOUS AND INFLAMMATORY DISEASES Jelliti Béchir (Fattouma Bourguiba University Hospital Monastir Tunisia) Khemakhem Riadh (Fattouma Bourguiba Unive rs i t y Hospital Monastir Tunisia), Messaoud Riadh (Fattouma Bourguiba University Hospital Monastir Tunisia), El Aini Najoua (Fattouma Bourguiba University Hospital Monastir Tunisia), Zaouali Sonia (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia), K h a i rallah Moncef (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia)
PO2-23-16 CHORIORETINAL INVOLVEMENT IN PATIENTS WITH WEST NILE VIRUS INFECTION Ben Yahia Salim (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia) Gargo u ri Salma (Fattouma Bourguiba University Hospital Monastir Tunisia) Ghrissi Rim (Fattouma Bourguiba University Hospital Monastir Tunisia) Dimassi Raafa (Fattouma Bourguiba University Hospital Monastir Tunisia) Messaoud Riadh (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia) K h a i rallah Moncef (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia) Introduction and objectives: To characterize and analyze the chorioretinal manifestations of West Nile virus (WNV) infection. Methods: Prospective, noncomparative case series including 41 consecutive patients with serologically confirmed WNV infection in the setting of an outbreak of the disease. The average duration of systemic symptoms before ophthalmic examination was 10 days (range, 2–30 days). All participants underwent a detailed ophthalmic examination at presentation and regularly throughout follow-up, including dilated biomicroscopic fundus examination, fundus photography, and fluorescein angiography. Results: A typical multifocal chorioretinitis was observed in 33 of 41 patients (80.5%). Chorioretinal lesions were bilateral in 31 eyes (75.6%). Multifocal chorioretinitis was associated with mild vitreous inflammatory reaction in all cases. Other findings included intraretinal hemorrhages (40 eyes [62.5%]), white-centered retinal hemorrhages (7 eyes [10.9%]), focal retinal vascular sheathing (5
Introduction and objectives: To report branch retinal artery occlusion (BRAO) in the setting of infectious and inflammatory diseases. Methods: Retrospective review of the charts of 14 patients (14 eyes). Results: The associations included ocular toxoplasmosis 6, rickettsiosis 4, West Nile virus infection 1, Behçet’s disease 1, Crohn’s disease 1, and idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) 1. BRAO resulted in decrease in visual acuity in 8 of 14 eyes (57.1%). Conclusion: Ocular toxoplasmosis and rickettsial infection were the most common conditions associated with BRAO. Physicians should be aware of such vision threatening complication of infectious and inflammatory diseases. Financial fundings: None Conflict of interest: None Keywords: Branch retinal artery occlusion, inflammation, angiography
PO2-23-18 NEURORETINITIS: A REVIEW OF 9 CASES Attia Sonia (Fattouma Bourguiba University Hospital Monastir Tunisia) Kahloun Rim (Fattouma Bourguiba University Hospital Monastir Tunisia), Jenzeri Salah (Fattouma Bourguiba University Hospital Monastir Tunisia), Jelliti Béchir (Fattouma Bourguiba University Hospital Monastir Tunisia), Zouid Sonia (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia), Khairallah Moncef (Fattouma Bourguiba Unive rsity Hospital Monastir
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Abstract Book PO2-23-20
Tunisia) Introduction and objectives: To assess the clinical features, etiologic profile, and management strategy of neuroretinitis. Methods: The study included 9 patients with neuroretinitis examined at the Department of Ophthalmology of Monastir (Tunisia) from 2002 to 2007. All patients had a comprehensive ocular and systemic history, including an extensive review of medical systems. Complete ophthalmic examination, fluorescein angiography, and systemic evaluation, including physical examination and laboratory screening investigations, were performed in all case. Results: The mean age was 19 years. Six patients were male, 3 patients were female. Neuroretinitis was unilateral in 8 patients and bilateral in one patient. Mean follow-up was 6 months. Initial visual acuity was ? 20/40 in 4 patients (40%). The etiologies of neuroretinitis were cat scratch disease in 2 patients (22.2%), toxoplasmosis in 2 patients (22.2%), toxocariasis in 1 patient (11.1%), rickettsia conorii infection in 1 patient (11.1%), and IRVAN in 1 patient (11.1%). The neuroretinitis was idiopathic in 2 patients (22.2%). Medical management included anti-infectious specific treatment (6 patients; 66.6%), and systemic steroids (3 patients; 33.3%). Final visual acuity was ? 20/40 in 8 eyes (80 %). Conclusions: Infectious diseases, including bartonellosis and toxoplasmosis, are the most common causes of neuroretinitis in our series. Such diagnosis should be kept in mind in order to maintain visual acuity by early diagnosis and appropriate therapy. Financial fundings: None Conflict of interest: None Keywords: Neuroretinitis, Cat scratch disease, management
PO2-23-19 CHORIORETINAL INVOLVEMENT IN PATIENTS WITH ACUTE MURINE TYPHUS Hmidi Kamel (Fattouma Bourguiba University Hospital Monastir Tunisia), Kammoun Skander (Fattouma Bourguiba Unive rs i t y Hospital Monastir Tunisia), Loba Adjon (Fattouma Bourguiba University Hospital Monastir Tunisia), Thabti Akram (Fattouma Bourguiba University Hospital Monastir Tunisia), Zaouali Sonia (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia), K h a i rallah Moncef (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia) Introduction and objectives: To describe chorioretinal changes in acute murine typhus (MT). Methods: Six consecutive patients (12 eyes) with serologically proven acute MT were examined by ophthalmoscopy, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Results: All eyes were affected as follows: white retinal lesions, 6; retinal hemorrhages, 3; retinal vascular leakage, 4; optic disc staining, 5; small well-delineated hypofluorescent dots, 12; and areas of hyperfluorescence on ICGA, 2. Conclusion: Typical ch o ri o retinal changes we re common in patients with acute MT. Fundus examination, complemented by FA and ICGA in selected cases, may be helpful in diagnosing MT while serologic testing is pending. Financial fundings: None Conflict of interest: None Keywords: Murine Typhus, Chorioretinitis, Angiography
DRUG-RESISTANT TUBERCULOUS CHOROIDITIS Fraser-Bell Samantha (Moorfields Eye Hospital), O'Toole Louise ( M o o r fields Eye Hospital), Pavesio Carlos (Moorfields Eye Hospital) Introduction/Objectives: The purpose of this report is to report an unusual case of a tuberculous choroiditis, which responded to quadruple therapy, reactivated upon discontinuation of Ethambutol, and responded again to re-introduction of the same drug. Case Report: A 17 year-old male presented with sudden onset of blurred right vision. Visual acuity (VA) was 6/24 right eye and 6/6 left eye with right vitreous haemorrhage. Within days, right VA improved to 6/6 and the haemorrhage cleared. A small lesion was noted in the superotemporal arcade with the appearance of an angioma. One month later his right VA fell to 6/36 and a well circumscribed creamy lesion associated with gross subretinal fluid was observed. Further questioning revealed history of exposure to a relative with primary TB. This person with primary TB, when treated with triple therapy failed to respond, but responded well to quadruple therapy. Results: Blood tests including serology for infectious diseases revealed no abnormalities. Following a positive Mantoux, triple anti-TB therapy was commenced (isoniazid, rifampicin, pyrazinamide) and prednisolone. However, one month later, there was no clinical improvement. Ethambutol was therefore added to his treatment regime. Over three months the choroidal lesion became organised with significant reduction in subretinal fluid. Ethambutol was ceased at this point with continuation of all other therapy. However, two weeks after cessation, a new lesion appeared, nasal to the optic disc. Ethambutol was recommenced, and the lesion again responded. Prednisolone was tapered and ceased after 7 months when his right VA was 6/12. Quadruple antiTB treatment was continued for 14 months. Conclusions: This case highlights the potential for resistant tuberculous choroiditis and the need to be aware of this in a patient who fails to respond on triple therapy. It also underscores the need for careful history taking, both for TB exposure and for exposure to persons with resistant strains. Financial fundings: Nil Conflict of interest: Nil Keywords: Tuberculosis, granuloma, choroid
PO2-23-21 SEVER OCULAR TOXOPLASMOSIS GIRAUDET Sylvia (CHU Ange rs ) , GIRAUDET Sylvia (CHU Angers), LAMIREL Cedric (CHU Angers), MAZIT Cherif (CHU Angers), JALLET Gishlaine (CHU Angers), COCHEREAU Isabelle (CHU Angers) Purpose: To describe the clinical, therapeutic and prognostic characteristics of ocular toxoplasmosis referred to an university ophthalmologie center. Methods: Retrospective case series from 2001 to 2006. Results: Forty patients were included. The sex ratio was 1. The average age was 35 years [12-73]. The average follow up was 21 months. Twelve of the 40 patients had already a history of a previous attack of ocular toxoplasmosis. Patients presented with an average visual acuity of 3/10, at least a active lesion, in the central area in 23 cases (57%), a vitritis (65%), anterior chamber cells (37%),or
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Abstract Book ocular hypertension (15%). An anterior chamber paracentesis was realized in 7 cases (useful in 2 cases). Thirty-six of the 40 patients received antiparasitic treatment until cicatrization. The average length of treatment was 10 weeks for pyrimethamine and 3.8 weeks for sulfadiazine. Sixteen patients had side effects; treatment was stopped in 7 patients, and 6 had another antiparasitic treatment. Systemic corticosteroids, of an average of 20 days long, were used in 70% of cases. After the resolution of the attack, main visual acuity was 6/10 [VLMB-10]. Nine recidives occurred, within average 18 months. Discussion: In this population reffered, the decrease of visual function, despite adapted treatment, is linked to the severity of the disease, in particular the location of the lesion in the macula. The delay for cicatrization is long, with an average of 10 weeks. The intolerance is due to mainly to antiparasitics, whereas systemic corticosteroid are well tolerated. Conclusion: Ocular toxoplasmosis may be a threat to the visual function. Extensive toxoplasmic retinochoroiditis necessitate a prolonged antiparasitic treatment, as well as a short corticosteroid treatment reacting fast, best started with intraveinous bolus. Financial fundings: (None.) Conflict of interest: (None.) Keywords: retinochoroiditis; intolerance; macrolid
PO2-23-22 OCULAR SYPHILIS: F ROM THE BIRTH TILL THE DEATH Sirtautiene Rasa (Vilnius university hospital), Bagdoniene Rasa (Vilnius University hospital) Introduction and objectives: Syphilis is a venereal disease that may present with a myriad of signs and symptoms, often imitating other disorders. We present different features of fundus changes seen in patients of various age groups. Methods: Funduscopic ex a m i n ation of premat u re infa n t s , teenagers and adults were performed. Results: Focci of different size in periferal retina of premature infants were found. The secondary stage of syphilis was characterized by chorioretinitis, vasculitis, optic neuritis. Syphilitic neuritis was found in both eyes of 15-years old girl. Tertiary syphilis was presented by bilateral optic nerve atrophy. Diagnosis of syphilis was confirmed by laboratory testing in all cases. Conclusions: The diagnosis of syphilis may be suspected based on signs and symptoms, but a definitive diagnosis is to be made by laboratory testing. Financial fundings: no Conflict of interest: no Keywords: Syphilis, congenital syphilis, tertiary syphilis
PO2-23-23 LASER-INDUCED CYTOMEGALOVIRUS RETINITIS VLEMING EDUARDO (HOSPITAL UNIVERSITARIO PRINCIPE DE ASTURIAS), GORROﾃ前 MARINA (HOSPITAL UNIVERSI TARIO PRINCIPE DE ASTURIAS)
Herpes virus retinitis is a common feature in HIV positive patients. Our patient was diagnosed HIV positive because an atypical necrotizing retinopathy of low aggresivity that probably flared up by laser photocoagulation. Case report: A 39 years old male that complained of decrease in visual acuity in his left eye. We could see a whitish lesion in peripheral retina with neither signs of swelling. In the f luorescent angiogram we could only see an extensive peripheral ischaemia in both eyes due to vascular occlusions. With the presumed diagnosis of Eales disease we started a systemic evaluation. All the results were negative with the exception of the VIH test. Laser photocoagulation of the ischaemic retina was performed while waiting for the results. Two weeks after the laser photocoagulation we could see a peripheral necrotizing retinitis adjacent to the laser scars. We started the treatment with intravenous foscarnet and steroids with excelent response. Comments: The only feature we saw in the patient before the diagnosis of HIV seropositivity was the peripheral retinal ischaemia. Only after the photocoagulation we could see inflammation with slow progression in a granular pattern. Other causes of retinal ischaemia in HIV positive patients have been described. Roth et al reported two cases of retinal ischaemia with slow progression to the posterior pole without any kind of inflammation and no response to antiviral treatment. This possibility in this patient with bilateral retinal ischaemia was discharged because the good response to the treatment. As it happens in other herpes related lesions it is known that external factors could induce its reactivation. The same may happen in the eye, the retinitis in this patient being induced probably by the photocoagulation of the ischaemic retina. To our knowledge this would be the first time that this effect is described after laser treatment. Financial fundings: (None.) Conflict of interest: (None.) Keywords: CYTOMEGALOVIRUS, LASER PHOTOCOAGULATION, RETINAL ISCHAEMIA
PO2-23-24 THE EFFECT OF THERAPEUTIC PARS PLANA VITRECTOMY FOR ENDOGENOUS UVEITIS Nishino Koji (Department of Ophthalmology, Ko chi Medical School, Japan), Nakakuki Toshiaki (Department of Ophthalmology, Kochi Medical School, Japan), Matsushita Eriko (Department of Ophthalmology, Kochi Medical School, Japan), Kondo Misuzu (Department of Ophthalmology, Kochi Medical School, Japan), Fukushima Atsuki (Department of Ophthalmology, Kochi Medical School, Japan), Ueno Hisayuki (Department of Ophthalmology, Kochi Medical School, Japan) Introduction and objectives: Pars plana vitrectomy (PPV) has both diagnostic and therapeutic effects in uveitis. Current reports demonstrated that PPV decreases the activity of uveitis and reduces the usage of immunosuppressive or anti-inflammatory medication. In addition, PPV decreases vitreous opacities and structural complication such as epiretinal membrane (ERM), cystoid macular edema (CME), and improves retinal detachment. We assessed the clinical outcome of PPV performed on patients with endogenous uveitis for in our institution. Methods: This is a retrospective study on 48 eyes of 39 patients with endogenous uveitis that underwent PPV for any reason.
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Abstract Book Surgery was performed in patients with severe vitreous opacities, ERM, CME, or retinal detachment and in those who responded poorly or not at all to conventional treatment for uveitis. The causes of uveitis were malignant lymphoma (9 eyes), sarcoidosis (4 eyes), Behcet?s disease (1 eye), acute retinal necrosis (1 eyes), HTLV-1 associated uveitis (1 eye) and unknown (32 eyes). Visual acuity, postoperative disease activity and postoperative complications were analyzed. Results: The visual acuity were improved by 2 lines or more in 33 eyes (68.8%), stable vision in 10 eyes (20.8%) and worsened by 2 lines or more in 5 eyes (10.4%). Six eyes (12.5%) subsequently experienced a recurrence of intraocular inflammation, and systemic treatment of corticosteroid was necessary. Tractional retinal detachment with proliferative vitreoretinopathy was noted in one patient. One patient of Behcet?s disease became phthisis bulbi. Conclusions: PPV may have beneficial effect on improvement or stabilization of visual acuity in more than 80% of cases. However, recurrence of uveitis was observed in some cases postoperatively. The management of postoperative recurrence of intraocular inflammation appears to be also important. Financial fundings: no funding for this research Conflict of interest: no conflict of interest Keywords: pars plana vitrectomy, endogenous uveitis, intraocular inflammation
PO2-23-25 PARS PLANA V I T R E C TOMY AND INTERMEDIATE UVEITIS WITH CYSTOID MACULAR EDEMA Vidovic Valentincic Natasa (Eye Clinic, University Clinical Centre, Ljubljana), Kraut Aleksandra (Eye Clinic, University Clinical Centre, Ljubljana), Stirn Kranjc Branka (Eye Clinic, University Clinical Centre, Ljubljana), Globocnik Petrovic Mojca (Eye Clinic, University Clinical Centre, Ljubljana) Purpose: Prospective, pilot study for evaluation of the efficacy of pars plana vitrectomy in the management of chronic intermediate uveitis (IU) with secondary cystoid macular edema (CME). Patients and methods: 5 eyes of 5 patients with chronic IU (average duration of the disease was 4,8 years +/-3,2) and secondary CME (average duration of CME was 2 years +/-1,3), unresponsive to medical treatment were chosen. They underwent pars plana vitrectomy with application of triamcinolone acetonide intravitreally. Indications for vitrectomy were the presence of CME and unresponsiveness to medical treatment. The primary outcome measures of the study were change in best corrected visual acuity (BCVA) and angiographic appearance of CME at 6 months and 1 year after surgery. Results: BCVA improved after 6 months in 3 patients (60%) and the improvement was clinically significant (improvement of BCVA for 2 Snellen lines or more). In 2 patients (40%) BCVA was unchanged (variations of BCVA in between 2 Snellen lines). At 1 year following vitrectomy BCVA in 1 patient from the last group deteriorated and deterioration was clinically significant (worsening of BCVA for 2 Snellen lines or more). CME was angiographically improved in all patients after 6 months; after 1 year 2 patients have the same CME as before the operation. They have a relapse of the disease. Conclusion: Pars plana vitrectomy with triamcinolone acetonide intravitreally is an efficient treatment method for our selected patients with chronic IU and secondary CME; 6 months after surgery all patients showed angiographic improvement in CME and in
3 patients BCVA was clinically significantly improved. 1 year after surgery there is a relapse of IU in 2 patients, other 3 patients don?t need any treatment. Larger study is needed to decide when the vitrectomy with triamncinolone acetonide intravitreally is the right treatment option for the patients with IU. Financial fundings: (None.) Conflict of interest: (None.) Keywords: INTERMEDIATE UVEITIS, VITRECTOMY, CYSTOID MACULAR EDEMA
PO2-23-26 POSTSURGICAL SYMPATHETIC OPHTHALMIA REFRACTORY TO TREATMENT: IS INFLIXIMAB THE ANSWER? Dorronzoro Emilio (Hospital Universitario La Princesa (Madrid) Introduction: To describe the evolution and response to therapy of a case of sympathetic ophthalmia (SO) during three years. Methods: interventional case report. Results: a 61 years old woman was diagnosed in May 2004, of postsurgical sympathetic ophthalmia two months after a phacovitrectomy because of a retinal detachment, the contralateral eye was in phitis. Treatment with oral prednisone (1,5 mg/kg/24h ) was initiated and slowly tapered during 3 months. With 20 mg /24h the inflammation relapsed and cyclosporine A 5 mg/Kg/24 was initiated, but due to renal toxicity the dose was reduced to 1mg/kg/24h, and azathioprine 1,5 mg/Kg/d was added. The treatment regime was not able to control the disease completely and in March 2005 we added mycophenolate mofetil (500 mg/day), with a total response. Seven months later because of another relapse we stopped mycofenolate and treatment with infliximab 5 mg/Kg in monthly intravenous infusion was initiated. The patient evolved satisfactorily and in January 2006 cyclosporine and azathioprine were withdrawn, prednisone was slowly reduced up to 10 mg/24h and maintaining infliximab with the same dose. We were not able to reduce the dose of the drugs or increase the infliximab infusion interval. In April 2007 the patient is stable with a VA of 20/20. Conclusions: The use of corticoids combined with immunosupressive drugs has improved the prognosis of the sympathetic ophthalmia but it is necessary a long term follow up to rule out the possibility of relapses and drugs adverse events. There are no published cases of the use of infliximab in the treatment of sympathetic ophthalmia. It is important to stablish an easily tolerated, comfortable and effective treatment for the patient due to the long evolution of the process. The treatment with infliximab is effective and well tolerated in resistant cases of SO and maybe used as first line therapy. Financial fundings: none Conflict of interest: none Key wo rd s : p o s t s u rgical sympathetic ophthalmia, i n fl i x i m ab, immunosupressive drugs
PO2-23-27 BIRDSHOT CHORIORETINOPATHY WITH PROTHROMBIN III GENE MUTATION- A RARE ASSOCIATION? Rane Tej M, (Royal Liverpool Unive rsity Hospital, United Kingdom), Bucknall C Roger (Royal Liverpool University Hospital, United Kingdom), Pearce A Ian (Royal Live rpool Unive rs i t y Hospital, United Kingdom)
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Abstract Book
Introduction: To report a case of Birdshot chorioretinopathy associated with prothrombin III mutation. To our knowledge this association with Birdshot chorioretinopathy has not been reported in literature. Method: Interventional case report. Result: A 49 year old female presented with a one year history of floaters, haloes associated with decreased vision in both eyes. She described a swelling on the left side of her neck with hot sensation around her face. She gave a past history of deep vein thrombosis 15 years ago. She had a family history of an early myocardial infarction in her father. Ocular examination revealed a corrected visual acuity was 6/5 N5 in both eyes. Anterior segments were normal in both eyes. Posterior segment showed bilateral vitreous cells associated with scattered pale choroidal lesions about 300-500 microns in size with periphlebitis in all 4 quadrants. The left fundus showed a peri-papillary choroidal neovascular complex with haemorrhage around the disc. Routine blood investigations, serology tests and X-ray chest were normal. Thrombophilia screening showed a raised antithrombin III levels and she was heterozygous for prothrombin III gene mutation. HLA typing showed a positive HLA A29 test. Doppler scan of the neck showed thrombosis of the internal jugular vein. She was commenced on a tapering dose of oral prednisolone and warfarin. Two months later her ocular symptoms improved. Fundus showed fewer vitreous cells with persistent scattered pale choroidal lesions without disc or macular oedema in both eyes. Conclusion: Birdshot Chorioretinopathy is a well known and rare form of posterior uveitis. There are a few known however no confirmed systemic associations. This case report suggests that prothrombin III gene mutation may be an association in a patient with Birdshot Chorioretinopathy. Financial fundings: There is no financial funding Conflict of interest: There is no financial funding Keywords: Birdshot chorioretinopathy, prothrombin III gene mutation, deep vein thrombosis
PO2-23-28 BA RTONELLA QUINTA NA INFECTION ASSOCIATED WITH STELLAR NEURORETINITIS Le Prince Anna Maria (CHI Toulon - La Seyne sur mer), Meunier Isabelle (CHI Toulon - La Seyne sur mer), Szo Timea (CHI Toulon - La Seyne sur mer), Sarfati Eric (CHI Toulon - La Seyne sur mer), Benhamou Robert (CHI Toulon - La Seyne sur mer) Introduction: To report an observational case of unilateral stellar neuroretinitis associated with Bartonella quintana infection. Methods: Review of the clinical, laboratory, photographic, and angiographic records of a patient with optic disc edema and stellar macular involvement. Results: A 31-year-old white woman reported to the clinic with decreased vision in the left eye over the preceding 4 days.The medical history was without predisposing factors and without symptoms of infection. The best-corrected vision acuity (VA) in the left eye was 20/100. Posterior segment examination on the left eye showed an optic disk edema with papillary and peripapillary hemorrhages and a stellar macular involvement. Fluorescein angiography showed late leakage of the disc. Physical and neuroophthalmologic consultation, neuroimaging studies, blood chemistry were normal, and serologic analysis (syphilis, lyme, toxoplasmosis and
HIV) negative. A Leber's idiopathic stellate neuroretinitis was suspected and the patient was treated with intravenous steroid pulses, which restored vision to 20/32 in 6 weeks. Five months later she presented a recurrent episode, with 20/200 VA, and flu-like symptoms. New serologic analysis was requested with positive serologic (IGG) titers to Bartonella henselae and Bartonella quintana. Bartonella quintana was confirmed by Western immunoblotting. The treatment was: oral doxycycline (200 mg), sulfamethoxazole (4g), trimethoprim (800mg) for 6 weeks. At the end of the treatment VA increased to 20/63, posterior segment showed optic disk pallor and macular hard exudates. Conclusions: Stellar neuroretinitis should alert suspicion of systemic disease like Bartonella quintana infection, which is transmitted by the body louse, especially if predisposing factors (poverty, low hygiene, and chronic alcoholism) are present. Financial fundings: (None.) Conflict of interest: (None.) Keywords: stellar neuroretinitis, bartonella quintana, Leber's idiopathic stellate neuroretinitis
PO2-23-29 RECURRENT ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY (APMPPE) ASSOCIATED WITH ACNE CONGLOBATA. Maria Garcia-Pous (Fundación Oftalmológica del Mediterráneo) Manuel Díaz-Llopis (Hospital General Universitario de Valencia), S a l vador Garc í a - D e l p e ch (Hospital General Universitario de Valencia), Amparo Navea Tejerina (Fundación Oftalmológica del Mediterráneo), David Salom Alonso (Hospital General Universitario de Valencia), Patricia Udaondo Mirete (Hospital General Universitario de Valencia) Introduction: APMPPE is an inflammatory retinal/choroidal disorder characterized by sudden loss of vision caused by yellowish inflammatory lesions located at the level of the retinal pigment epithelium and choricapillaris. Acne conglobata is an uncommon nodulocystic condition characterized by inflammatory infiltrate around follicles with the disruption of the normal dermal architecture. Case report: 26 year-old man, with a history of recurrent and bilateral APMPPE since 6 years ago and a serious acne conglobata resistant to treatment since then. HLA-DR2 positive. He refers bl u rred vision, photopsias and para c e n t ral scotomas in each episode with good response to systemic corticoid therapy. Actually, visual acuity in right eye is 20/40 and in the left 20/60, with retinal pigment epithelium atrophy in posterior pole with hipo and hyperfluorescence in the fluoresceingraphy. Multifocal electroretinography shows a macular dysfunction more widespread than the subjective visual field testing. Acne conglobata has been treated with multiple therapy with no response, including infliximab. Actually, he is in surgical treatment of the multiple nodules and abscesses, and this treatment increases ocular recurrences. Conclusions: The etiology and pathogenesis of acne conglobata and the hidradenitis suppurativa remain unknown, but many reports associated these skin desease with inmunologic disorders such as seronegative spondylarthropathies. HLA B7 and DRW4, isolated elevations of immunoglobulins, C3 and C4, and inmnue complexes have been described in this entity.These observations suggest that immunogenetic mechanisms may play a role in the manifestations of these skin diseases, and maybe the ocular manifestation can be related. The etiology for APMPPE is not well understood
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Abstract Book but an ab n o rmal immune response has been postulated. Associations with HLA-B7 and HLA-DR2 also have been reported. We didn’t find previous reports in the literature about APMMPE and acne conglobata association. Financial fundings: the authors don't have any financial interest in this case Conflict of interest: (None.) Keywords: acute posterior multifocal placoid pigment epitheliopathy, acne conglobata, white dot syndromes
PO2-23-30 MULTIFOCAL ELECTRORETINOGRAM FINDINGS AND COMPARISON WITH OCT RESULTS IN A STUDY OF PATIENTS WITH BIRDSHOT CHORIORETINOPATHY Monnet Dominique (Hopital Cochin), Streho Mate (Hopital Cochin)Ingster-Moati Isabelle (Service de physiologie), Haddad Lamine (Hopital Coch i n ) , Brézin Antoine (Hopital Cochin), Monnet Dominique (Hopital Cochin) Introduction: To describe multifocal electroretinogram (mfERG) features, and their relationship to optical coherence tomography (OCT) results in patients with birdshot chorioretinopathy (BCR) Methods: In a single-center, cross sectional study of 87 HLA-A29-positive patients with BCR underwent a standardized examination including mfERG and OCT in November 2005. MultifocalfERG was obtained following ISCEV recommendation. The N1 (first negative trough) and P1 (first positive peak) components of the first order kernel response were measured on the central 2, 5 and 10 degrees and compared with macular thickness and volume on OCT. Results: There were 35 males and 52 females and the mean age was 56,4 years [24-81] .The mean duration of the disease was 5,4 years [0,1-33,5]. The N1 and P1 components on the central 2° were correlated with the best-corrected visual acuity (p<0.001). The N1 implicit time on 2° and 5° was correlated with the macular thickness on the OCT (2°,R=0,23 , p=0,004; 5°, R=0,24 , p<0,001). The N1 implicit time on 10° was correlated with the macular volume on the OCT (N1/10° , R=0,24 , p=0,002). However, there were no significant correlation between N1 amplitude, P1 amplitude, P1 implicit time on 2° and 5° and macular thickness on OCT. There were no significant correlation between N1 amplitude, P1 amplitude or P1 implicit time on 10° and macular volume on OCT. Conclusions: There is a significant correlation between the N1 implicit time for all the degrees and macular thickness or volume on OCT. These findings suggest that the N1 implicit time is the most reliable mfERG indicator in the birdshot chorioretinopathy. This result is to be linked with global ERG studies that showed the cone b-wave flicker implicit time to be the most clinically reliable parameter. Financial fundings: None Conflict of interest: None Keywords: POSTERIOR UVEITIS, ERG MULTIFOCAL, OCT
Venice ), Tempesta Daniele (Hepatology Department- Umberto I Hospital - Mestre Venice) Introduction: A case of onset of birdshot chorioretinopathy has been reported after interferon alpha treatment for hepatitis Methods: Observational case report Results: A 50 year old man presented birdshot chorioretinopathy after a 4 months treatment with interferon alpha for hepatitis C. He was previously tested for immunological disease before treatment and serological examination showed a fair positivity of ANA ( 1:160). An hepatic biopsy was unremarkable. No association with HLA A29 or B12 was found. Conclusion: Interferon alpha has previously been associated with retinopathy, most commonly cotton wool spots and hemorrahages are present, but there are no reports ,to our knowledge, about the onset of birdshot choriorethinopathy. Is questionable the necessity to point out further criteria of exclusion for therapy in order to prevent the onset of hyatrogenic immunological disease. Financial fundings: (None.) Conflict of interest: (None.) Keywords: birdshot chorioretinopathy, interferon alpha, hepatitis C
PO2-23-32 PARS PLANA VITREOUS SURGERY IN UVEITIS Gupta Vishali (Post Graduate Institute of Medical Education and Research, Chandigarh) Gupta Amod (Post Graduate Institute of Medical Education and Research, Chandigarh), Nijhavan Raje (Post Graduate Institute of Medical Education and Research, Chandigarh) Introduction and Purpose: To report our experience of 45 patients of uveitis who underwent pars-plana vitrectomy (PPV) for variable indications. Methods: 20-G PPV was done in 37 patients and 8 patients underwent 25 G PPV for diagnosis- therapy (33patients) or therapeutic (12 patients).The sample from diagnostic vitrectomies was subjected to laboratory investigations. The indications for therapeutic PPV included vitreous hemorrhage (5), Cystoid macular edema (3), retinal detachment (2) and epiretinal membrane (2). Results: There were 20 males, 13 females with age ranging between 5-72 years. The diagnosis could be established in 26 of 33 eyes (79%). Twenty of these 33 eyes showed at least one line improvement in visual acuity (60%).In patients undergoing therapeutic vitrectomy, 2 lines-improvements was seen in 8 of 12 patients (67%). Conclusions: Pars plana vitrectomy is safe and effective procedure for diagnosis and management of recalcitrant uveitis Financial fundings: None Conflict of interest: None Keywords: Pars plana vitrectomy, cytology, Vitreous biopsy
PO2-23-33 PO2-23-31 ONSET OF BIRDSHOT CHORIORETINOPATHY AFTER INTERFERON ALPHA THERAPY Martello Claudia (dep a rtment of ophthalmology- Umberto I Hospital - Mestre Venice), Zancanaro Andrea (department of inter nal medicine-Umberto I Hospital - Mestre Venice, Panese Sandro (department of infectious disease -Umberto I Hospital - Mestre
VITREOUS INVESTIGATION AFTER VITRECTOMY IN DIAGNOSIS OF INFECTIOUS UVEITIS AND V I T R E OMACULAR TRACTION SYNDROME GAVALA CAT E R I NA (IPPOCRATIO GENERAL HOSPITAL) KIRIAKOPOULOS NIKOS (IPPOCRATIO GENERAL HOSPITAL) PAPADOPOULOU ANATOLI (IPPOCRATIO GENERAL HOSPI TAL), GEORGANTIS HLIAS (IPPOCRATIO GENERAL HOSPI -
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 147
Abstract Book TAL), KOTSIDAS IOANNIS (IPPOCRATIO GENERAL HOSPI TAL), TOTO LISA (UNIVERSITA DEGLI STUDI " G. D`ANNUN ZIO" CHIETI-PESCARA) O b j e c t ive: To indentify infectious organism causing uve i t i s , describing the role of vitreous biopsy in patient’s management. Methods: From June 2002 to January 2007 11 eyes of 11 patients ,8 male and 3 female, from 28 to 52 years of age, with suspected infectious uveitis that had developed vitreomacular traction , were submitted to therapeutic and diagnostic vitrectomy. Vitreous washings were examined for the causative organism identification with cytologic, cytofrorografic or microbiologic analysis. Results: Infection was confirmed in 7 of 11 eyes (63,63%). Mean duration of uveitis before vitrectomy was 13 months. Only 3 of 11 (27,27%). had predisposing factors such as immunosuppression , trauma or previous ocular surge ry. Pro p i n ebacterium Acnes, Candida, and Herpes Simplex were isolated by culture while PCR (Polymerase Chain Reaction) showed Varicella Zoster, Cytomegalovirus, Mycobacterium Tubercolosis, and Toxoplasma Gondii. One patient showed a cytofluorograf ic positive exams standing for immunologically mediated uveitis. Conclusion: Low virulence microorganism seam to be the cause of chronic uveitis. Vitrectomy can be important in exact diagnosis and treatment of infectious uveitis, as it allows isolation of pathogenic organism, and target therapy. Financial fundings: (None.) Conflict of interest: (None.) Keywords: infection,uveitis,vitrectomy
PO2-23-34 ANALYSIS OF V I T R E C TOMY FOR ACUTE RETINA L NECROSIS K i mu ra Motoki (Ophthalmology,Kansai Medical University), Kimoto Takashi (Ophthalmology,Kansai Medical Unive rs i t y ) , Nakauchi Tadashi (Ophthalmology, Matsushita Memorial Hospital), Otsu Yayoi (Ophthalmology,Kansai Medical University), Nishimura Tetsuya (Ophthalmology,Kansai Medical University), Matsumura Miyo (Ophthalmology,Kansai Medical University) Purpose: To evaluate surgical outcomes of vitrectomy performed to prevent retinal detachment in cases of acute retinal necrosis (ARN) and to determine indications for silicone oil tamponade. Patients and Methods: This study included 10 eyes of 10 patients (3 male, 7 female) followed up for more than 3 months after surgery. Ages ranged from 12 to 87 years (mean, 47). Periods of observation ranged from 4 months to 4 years and 5 months, (mean, 2 years and 4 months). Vitrectomy, performed after onset of retinal detachment or increased vitreous opacity, was preceded by treatment consisting of systemic acyclovir, systemic and local corticosteroids, and aspirin. Serum IgG antiviral titers or polymerase chain reaction analysis of intraocular fluids obtained during surgery were the bases for etiologic diagnosis. Results: Nine eyes were positive for varicella-zoster virus, and another was positive for herpes simplex virus type 2. Five eyes (50%) attained final visual acuity of 20/200 or better. Exudative lesion extended to the posterior pole of the retina in five eyes, which attained a final visual acuity of less than 20/200. Silicone oil tamponade was used in eight eyes, and in five of these eyes the oil could not removed subsequently because of hypotony. Retinal detachment did not occur in seven eyes operated upon before onset of retinal detachment. One eye showing pro l i fe rative vitre o-
retinopathy at the initial visit failed to attain retinal attachment after surgery. Conclusions: Final visual acuity was unfavorable if the posterior chamber was involved by an exudative process. Vitrectomy with silicone oil tamponade proved useful in prevention of retinal detachment caused by ARN. Financial fundings: (None.) Conflict of interest: (None.) Keywords: Acute Retinal Necrosis,Vitrectomy,Uveitis
PO2-27-01 BEVACIZUMAB IN PATIENTS WITH NON- ISCHEMIC RETINAL CENTRAL VEIN OCCLUSION Authors: B. Bajaire, A. Leon, A.zabaleta. Affilation: Olsabe ophthalmologic Center, Oftalmosanitas, San Martin University Ophthalmology Departament, Bogota Proposal: E va l u ate the functional and anatomical effect of Bevacizumab in patients with non- ischemic retinal central vein occlusion. Materials and method: prospective analysis of 11 patients with non-ischemic retinal central vein occlusion, Who received injection of bevacizumab 2,5mg. Visual acuity and change of the macular thickness for Optical CoherentTomograp hy and adve rse effects we re eva l u ated in patients 3 to 6 months later after the Bevacizumab injection. Result: The initial visual acuity of 11 patients was under 20/200 in 1 eyes (9%), 20/200 to 20/50 in 9 eyes (82%) and higher or equal to 20/40 in 1 eye (9%). The visual acuity in 11 eyes after 3 to 6 moths after the medicament injection was 20/200 to 20/50 in 7 eyes (64%) and less or equal to 20/40 in 4 eyes (36%) . The initial macular thickness in the eyes with non-ischemic Retinal Central Vein Occlusion varied between 791um and 241um with 433um average. The macular thickness varied between 759 um and 164um with a 285um, it means that the macular thickness decreased to 148um (34.5%) average. There were not complications neither intra nor postoperative the bevacizumab injection. Conclusions: The intravitreal Bevacizumab decreased 34.5% the retinal macular thickness and improved 45% of the function in patients with non ischemic Retinal Central Vein Occlusion without any adverse effect. Financial fundings: none Conflict of interest: none Keywords: vein Occlusion, Bevacizumab, macular thickness
PO2-27-02 BEVACIZUMAB TREATMENT FOR INFLAMMATO RY MACULAR EDEMA Julián Lilian K (Hospital Universitario Austral), Martinez Cartier D Mauricio (Hospital Universitario Austral), Couto A Cristóbal (Universidad de Buenos Aires) Introduction and Objetives: cystoid macular edema (CME) is a major cause of decreased visual acuity in uveitis patients. Its impact differs among the diverse anatomic types of uveitis being panuveitis and intermediate uveitis those with maximal visual impairment from CME. Corticosteroids are the mainstain of treatment but several times its side effects limits their use. We report two patients who received intravitreal (IV) Bevacizumab as treat-
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Abstract Book ment for inflammatory CME. Methods: three eyes of two patients with chronic inflammatory CME were treated with IV Bevacizmab 1.25mg/0.05ml. Main outcomes were best corrected visual acuity (BCVA), fluorescein angiograms (FA) and macular thickness measurements by Optical Coherence Tomography (OCT). Results: both patients had previously been treated with corticosteroids without improvement. The first case was a 80 year-old woman with longstanding multifocal choroiditis and panuveitis who needed discontinuation of therapy because of glaucoma and systemic hypertension. By the time she received the injection visual acuity OD was 20/200, FA showed macular leakage and macular thickeness was 300μm. One month after the injection the visual acuity was 20/50, FA showed reduction in leakage and the macular thickeness was 191μm. The second case was a 12 year-old girl with CME secondary to pars planitis. The BCVA was 20/400 OD and 20/100 OS, FA was consistent with CME and macular thickeness was 443μm OD and 244μm OS. She received one injection in each eye and the BCVA one month later was 20/60 OD and 20/50 OS. FA showed improvement in macular leakage and OCT thickeness was 326μm OD and 230μm. Conclusions: IV Bevacizumab treatment produced anatomical and functional improvement in our patients with uveitis-related CME. Larger controlled studies are necessary to confirm the long-term efficacy and safety of this treatment. Financial fundings: no Conflict of interest: no Keywords: CME, uveitis, treatment.
PO2-30-01 CLINICAL FEATURES OF PATIENTS WITH ACUTE RETINAL NECROSIS SYNDROME IN JAPAN Usui Yoshihiko (Department of Ophthalmology, Tokyo Medical U n ive rsity) Take u chi Masaru (Dep a rtment of Ophthalmology, Tokyo Medical Unive rs i t y ) , Kezuka Takeshi (Department of Ophthalmology, Tokyo Medical Unive rs i t y ) , Mori Hideki (Department of Ophthalmology, Tokyo Medical University), Sakai Ju n - i chi (Dep a rtment of Ophthalmology, To kyo Medical University), Goto Hiroshi (Department of Ophthalmology, Tokyo Medical University) Objectives: To describe the clinical features and prognosis of acute retinal necrosis in Japanease patients. Methods: Eighty Japanese cases diagnosed as having acute retinal necrosis at the uveitic clinic of Tokyo Medical University Hospital between January 1985 and March 2006 were analyzed. Results: Eighty patients with acute retinal necrosis were identified, 52 (65%) of whom were males. Mean age was 48.9 ? 13.9 years (range, 14 to 85 years). Unilateral involvement was noted in 73 patients (91.3 %). Varicella-zoster virus (VZV) was detected in 67 patients and herpes simplex virus (HSV) in 13. Mutton fat keratic precipitates were noted in 68 patients (85.0 %). Patients with better visual acuity at presentation had significantly better visual acuity at final follow-up (p<0.0001). Logistic regression analysis indicated that the presence of retinal detachment and VZV was significantly associated with poor visual outcome (<20/200). The patients who presented during the 2000-2006 period had a significantly better visual outcome at both the first and the last examinations than the patients during the 1988-1999 period. Conclusions: A review of our series of 80 Japanese patients with acute retinal necrosis indicates that the presence of retinal detach-
ment and VZV in the eye is important risk and prognostic factor for visual outcome. Visual outcome is strongly related to preoperative visual acuity. Although medical and surgical therapies cannot prevent the occurrence of retinal detachment in acute retinal necrosis syndrome, our results suggest that early detection and adequate therapy are important for visual prognosis. Financial fundings: (None.) Conflict of interest: (None.) Keywords: acute retinal necrosis syndrome, visual prognosis, herpes viruses
PO2-30-02 AN ASSOCIATION OF VARICELLA-ZOSTER V I RU S LOAD IN THE AQUEOUS HUMOR WITH CLINICAL MANIFESTATIONS OF ANTERIOR UVEITIS IN HERPES ZOSTER OPHTHALMICUS AND ZOSTER SINE HERPETE Horie Shintaro (Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University, Tokyo, Japan), Sugita Sunao (Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University, Tokyo, Japan), Kido Sayaka (Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University, Tokyo, Japan), Shimizu Norio (Department of Virology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan), Morio Tomohiro (Center for Cell Therapy, Tokyo Medical and Dental University, Tokyo, Japan) M o chizuki Manabu (Dep a rtment of Ophthalmology & Visual Science, Tokyo Medical and Dental University, Tokyo, Japan) Objectives: To investigate whether clinical manifestations of anterior uveitis is associated with viral load of varicella-zoster virus (VZV) in the aqueous humor in patients with herpes zoster ophthalmicus (HZO) and zoster sine herpete (ZSH). Methods: An aliquot of aqueous humor (Aqh) of patients with HZO (n=4) and ZSH (n=2) were collected after informed consent was given. Using the Aqh, genomic DNA of human herpes viruses were measured by two polymerase chain reaction (PCR) assays: (1) a qualitative multiplex PCR and (2) quantitative real-time PCR. Results: All patients had unilateral acute anterior uveitis with high intraocular pressure, mutton fat keratic precipitates with some pigmentation, and pigmentation in the trabecular meshwo rk . Multiplex PCR demonstrated VZV genomic DNA in the all samples, but not other human herpes virus (HSV-1, HSV-2, EBV, CMV, HHV-6, HHV-7, and HHV-8). Real-time PCR revealed a high copy number of VZV DNA in the Aqh. Iris atrophy and distorted pupil with paralytic mydriasis were developed some time after the onset of anterior uveitis. The intensity of iris atrophy and pupil distortion, but not ocular hypertension, was correlated with the viral load of VZV in the Aqh Conclusions: Viral load of VZV in the Aqh was well correlated with tissue damages of the iris (iris atrophy and pupil distortion) in patients with HZO and VSH. Financial fundings: (None.) Conflict of interest: (None.) Key wo rds: va ri c e l l a - zoster virus, poly m e rase chain reaction, uveitis
PO2-30-03 THE TREATMENT MODALITIES AND PROGRESSION OF ACUTE RETINAL NECROSIS EVALUATED BY PCR Arimu ra Eiko (Sakai Hospital Kinki University School of Medicine), Maruyama Ko i ch (Kinki Unive rsity School of
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Abstract Book Medicine), Matusmoto Chota (Kinki Unive rsity School of Medicine), Takada Sonoko (Kinki University School of Medicine) Introduction and Objective: Currently photocoagulation and antiviral drugs are the available treatment modalities for acute retinal necrosis (ARN) depending on the advance of the disease. We evaluated the treatment options based on the pathogenic viruses and disease progression. Methods: Subjects were ten patients with ARN, who were detected with either herpes simplex virus - DNA (HSV-DNA) or herpes zoster virus - DNA (VZV-DNA) in aqueous humor by polymerase chain reaction (PCR). All subjects underwent ocular examinations for the evaluation of retinal damage and were treated with corticosteroid, antiviral and anticoagulant drugs. While pars plana vitrectomy, placement of encircling band, and temporary tamponading of silicon oil were performed along with cataract surgery on three patients with extensive retinal damage, severe vitreous opacity, and without retinal detachment, conservative therapy including medical treatment and photocoagulation was given to the other seven patients with localized retinal damage. Visual acuity before and after therapy, incidence of retinal detachment, and duration of treatment were assessed in all subjects within a 6-month period. Results: VZV-DNA was detected in two of the three patients who received surgical treatment and HSV-DNA was detected in four of the seven patients with conservative therapy. Neither treatment group had patients with retinal detachment. Six of the seven patients with conservative therapy had maintained or improved visual acuity, whereas those three patients with surgical therapy had deteriorating visual acuity postoperatively. Conclusions: Our result has shown that the progression of the retinal damage had caused deterioration in visual acuity even if an effective surgery was performed. Furthermore, patients detected with VZV-DNA can possibly preserve or improve their visual acuity as long as the retinal damage is localized. Therefore, early detection and treatment to minimize retinal damage are essential to the treatment for ARN. Financial fundings: (None.) Conflict of interest: (None.) Keywords: ARN, PCR, treatment modalities
PO2-30-04 C Y TO M E G A L OVIRUS UVEITIS IN IMMUNOCOMPETENT PATIENTS A c c o rinti Massimo (Dipartimento di Scienze Oftalmologi ch e, Università di Roma "La Sapienza", Rome, Italy) Pirraglia Maria Pia (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy ), Iannetti Ludovico (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy), Pesci Francesca Romana (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy), Palermo Eliana (Dipartimento di Scienze Oftalmologi ch e, Università di Roma "La Sapienza", Rome, Italy), Abdulaziz Randa (Dipartimento di Scienze Oftalmologiche, Università di Roma "La Sapienza", Rome, Italy) Introduction and Objective: to report additional information on the possible role of cytomegalovirus (CMV) in the etiology of anterior uveitis. Methods: five patients, 4 males and 1 female, average age 49 ± 10.32 years (range: 32-58 years) with anterior, recurrent or chronic, hypertensive uveitis and without corneal involvement, under-
went an anterior chamber paracenthesis. Aqueous humour was analyzed for viral DNA (HSV, VZV, EBV, CMV) by polymerase chain reaction (PCR). As control group seven patients with uveitis and without ocular hypertension and corneal involvement were submitted to the same procedure. Results: 4 out of 5 aqueous humor of patients with hypertensive uveitis were positive for CMV (80%), none for the other viruses. In one of the subjects who were analyzed before cataract extraction, CMV DNA was also present in the lens. In the control group no patient resulted positive for viruses (chi-square: 5.186, p=0.023) Conclusion: cytomegalovirus might be an important cause of hypertensive anterior uveitis in immunocompetent patients Financial fundings: None Conflict of interest: None Keywords: cytomegalovirus, uveitis, PCR
PO2-30-05 UNUSUAL PRESENTATION OF HYPERTENSIVE UVEITIS Kaines Andrew J, Pavesio Carlos (Moorfields Eye Hospital) An 82 year female presented with hypertensive anterior uveitis after starting chemotherapy and high dose steroids for light chain myeloma. She was started on maxidex and IOP lowering medication. Retinal examination was normal. Over the next 4 weeks there was a progressive loss of right visual acuity. The left eye had acuity of 6/6 and was unaffected throughout. Four weeks after symptoms started she presented to the uveitis / medical retina clinic with acuity of 1/60 and a right afferent papillary defect. Examination showed mid peripheral closure of both arteries and veins with an abrupt haemorrhagic border. There was no area of retinal opacity. She had a moderate vitritis and flourescein angiography showed disc swelling. There was no rubeosis. The clinical picture was very atypical for inflammatory, hyperviscosity / vascular or infective disease. Since only the latter remained uninvestigated and untreated, a vitreous tap was performed. She was given intravitreal foscarnet and systemic valacylovir to cover herpetic uveitis. The vitreous tap was polymerase chain reaction positive (with high copy numbers) for Cytomegalovirus. It was negative for Herpes Simplex Virus and Varicella Zoster Virus. The treatment was changed to valgancyclovir. A small area of retinitis more typical of CMV developed but then inflammation, intraocular pressure and clinical signs resolved with treatment. This case represents an unusual presentation of hypertensive uveitis secondary to CMV. Financial fundings: nil Conflict of interest: nil Key wo rds: CMV retinitis, hypertensive uveitis, diagnostic dilemma
PO2-30-06 SPECTURM OF RESPONSE TO INTRAVITREAL GANCICLOVIR IN THE MANAGEMENT OF NON AIDS RELATED CMV RETINITIS L a n g n e r- Weg s cheider Beate J (Medical University of Gra z , D ep a rtment of Ophthalmology, Au s t ria), M u ra Marco (AMC Amsterdam, Department of Ophthalmology, The Netherlands), Faridpooya Koorosh (AMC Amsterdam, Department of Ophthalmology, The Netherlands), de Smet D Marc (ZNA Middelheim, Department of Ophthalmology, Belgium)
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Abstract Book
Objective: To report and evaluate intravitreal ganciclovir injections in non AIDS patients with human cytomegalovirus (HCMV) retinitis. Method: Retrospective analysis of three iatrogenically immunocompromised patients with HCMV retinitis who were treated with intravitreal ganciclovir injections in order to avoid side effects of systemic antiviral therapy. Results: Intravitreal ganciclovir injections were well tolerated and led to remission of the retinitis in two patients. In patient one FACS analysis had shown low CD4 and CD8 while being treated with systemic ganciclovir which recovered with intravitreal treatment. Patient two had developed thrombocytopenia during treatment with systemic foscarnet, which could be evaded using intravitreal antiviral treatment only. Patient three had suffered persistent disease for a period of six months when treatment was changed from systemic to intravitreal ganciclovir but reached quiescence only using an intravitreal ganciclovir implant. Conclusion: Intravitreal ganciclovir injections should be considered as a treatment option in selected iatrogenically immunocompromised patients with HCMV retinitis especially when recovery of the immune system is delayed, or the patient has experienced side effects from systemic treatment. Responses may vary and will require an adjusted approach to treatment. Financial fundings: none Conflict of interest: none Keywords: uveitis, intravitreal treatment, cytomegalovirus
PO3-16-01 FUNGAL SCLERAL ABSCESS MIMICKING NODULAR SCLERITIS Tesavibul Nattaporn (Siriraj Hospital, Mahidol University) Objective: To report a case of Fusarium scleral abscess mimicking nodular scleritis. Methods: A 57-year-old diabetic woman was referred with a non-traumatic refractory nodular scleritis in the right eye which was treated with systemic steroid and azathioprine. The inflammation partially responded but the nodule persisted. Subconjunctival triamcinolone injection was performed resulting in a non-inflamed enlargement of the nodule within a few weeks. Scleral biopsy revealed an abscess with mucopurulent content. Results: Gram stain from the eye drainage re vealed numerous branching septate hyphae and cultures/ sensitivity testing yielded Fusarium species which resisted to amphotericin B, itraconazole and fluconazole. The patient was successfully treated with systemic voriconazole and local debridement. The lesion gradually resolved leaving an area of scleral thinning after a period of 6 weeks voriconazole treatment. Conclusions: Fungal scleral abscess in a non-surgical eye can mimic a non-infectious scleritis. Cautious use of steroid, regular follow up and prompt surgical intervention are important in dealing with an intriguing case. Financial fundings: hospital funding Conflict of interest: none Keywords: Fusarium scleral abscess, nodular scleritis, voriconazole
PO3-16-02 Triple topical therapy in necrotizing scleritis Goldhardt Raquel, Conway D. Mandi, Peyman Gholam (TULANE UNIVERSITY) Purpose: To report successful use of triple topical therapy in necrotizing scleritis. Introduction: Acute necrotizing scleritis is a severe, chronic, progressive, potentially blinding inflammatory process of the sclera. It is commonly associated with systemic disease and generally requires systemic therapy including corticosteroids and immunosuppressive drugs to control disease and preserve vision. Systemic corticosteroid use may result in adrenal suppression, osteoporosis, blood pressure elevation and other complications. Immunosupressive agents can lead to severe complications including but not limited to renal, hepatic and hematologic disorders, malignancy and sterility. Methods: We report two cases of acute necrotizing scleritis wh e re three topical agents we re used in combination: Dox y cy cline 10mg/ml, Triamcinolone 40 mg/ml and Levenox 10 mg/ml (low molecular weight heparin (LMWH). The cases are rev i ewed and outcomes descri b e d. Results: Marked improvement of the symptoms and remission using triple topical therapy were observed with a followup of 6 months and 3 months, re s p e c t ively. Conclusion: Correct diagnosis and management of necrotizing scleritis is essential to maintaining sight in these severely thre atened eyes. Combining topical treatment as we describe may minimize the need for systemic immunosuppression, while resulting in acceptable outcomes, in cases where an identifiable underlying systemic disease requiring systemic immune modulation is absent. Financial fundings: None of the authors have any financial interest in the treatments discussed in this work. Conflict of interest : There are no conflicts of interest issues raised herein. Keywords: Scleritis, topical therapy, angiogeneses inhibition PO3-16-03 SYSTEMIC AND OCULAR SIGNS AND ETIOLOGY OF SCLERITIS Schlaen Ariel A (Universidad de Buenos Aires ) Couto A Cristobal (Universidad de Buenos Aires) Purpose: To describe ocular ,extraocular signs, etiology of scleritis. Methods: Patients with diagnosis of scleritis , between june 2000 to april 2005 was included in this series. Age, gender, type of scleritis, uni or bilateral involvement, etiology, ocular signs, ex t raocular signs, and treatment we re re c o rd e d. Results: Twenty seven patients (35 eyes) with diagnosis of scleritis were included. Fourteen patients (51.85%) had a defined etiology. Thirteen of these cases had systemic dise a s e, and 1 patient had local pat h o l ogy. Ten patients (37.03%) had an inflammatory disease, while 4 patients (14.81%)had an infectious disease. Recorded etiologies
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Abstract Book were: rheumatoid arthritis, Wegener disease (WD), systemic lupus eritematosus, relapsing polichondritis, syphilis, tuberculosis, bacterial infectious scleritis (BIS). Recorded types of scleritis were: diffuse (11 patients, 15 eyes: 42.86%), nodular (15 patients, 17 eyes: 48.57%), necrotizing with inflammation (4 patients, 4 eyes: 11.43%), y posterior (5 patients, 8 eyes: 22.86%). All those patients with necrotizing scleritis had an associated etiology (75% with WD, 25% BIS). Patients with diffuse scleritis, had a defined etiology in 63.63% of cases. Patients with nodular scleritis and those with posterior scleritis, had an associated etiology in 40% of cases, respectively. Most frequent recorded ocular signs were: anterior uveitis (34.28%), interstitial keratitis (20%), ocular hipertension (14.28%), cataract (14.28%), papillary edema (8.57%), macular edema (5.72%), retinal vasculitis (5.72%), y panuveitis (5.72%). Extraocular signs found in this series were: arthritis, renal failure, saddle nose deformity, sacroiliitis, malar erythema, p u l m o n a ry cave rn , p u lmonary nodules, chondritis, genital chancre, and Addison disease. According to the etiology, patients were treated with s p e c i fic therapy or immu n o s u p p re s s ive agents. Antiinflammatory and immunosuppressive agents used were: NSAIDs; prednisone, azathioprine, methotrexate, chlorambu c i l , cyclophosphamide , mycophenolate mofetil, cy cl o s p o rine A, etanerc ep t , i n fl i x i m ab and adalimumab. Conclusion: Systemic etiology should be investigated in patients with scleritis. Financial fundings: none Conflict of interest : none Keywords: SCLERITIS, SYSTEMIC DISORDER, IMMUNOSUPPRESSIVE AGENTS
PO3-16-04 A CASE OF POSTERIOR SCLERITIS: DELAYED DIAGNOSIS KIM YOON HEE Posterior scleritis is a serious ocular inflammatory and potentially blinding disorder. It is uncommon and likely to be under-recognized due to its varied presentations. Visual disturbances such as blurring or distortion are the commonest symptoms, but which may be concealed by other existing causes of blurring. In such a case accurate diagnosis may be dalayed and proper management fails to be accomplished. We report a patient who had posterior scleritis with relatively thick cataract of anterior polar type. She had complained red eye and mild ocular discomport, and denied visual change. Her problem had been diagnosed as anterior uveitis at a previous hospital, and she was referred to our hospital with aggravated symptomes. Financial fundings: (None.) Conflict of interest : (None.) Keywords: posterior scleritis, existing causes of blurring
PO3-16-05 POSTERIOR SCLERITIS: A REVIEW OF 12 CASES Attia Sonia (Fattouma Bourguiba University Hospital Monastir Tunisia), Bouladi Majda (Fattouma Bourguiba University Hospital Monastir Tunisia), Ben Amor Hajer
(Fattouma Bourguiba University Hospital Monastir Tunisia), Hmidi Kamel (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia), Kammoun Skander (Fattouma Bourguiba University Hospital Monastir Tunisia), Khairallah Moncef (Fattouma Bourguiba University Hospital Monastir Tunisia) Introduction and objectives: To assess the clinical features, the management guidelines and the clinical course in 12 patients with posterior scleritis. Methods: All patients underwent a complete ophthalmic ex a m i n ation and B-scan ultra s o n ograp hy. Fluorescein angiography was performed in 11 patients. Systemic evaluation, including physical examination and laboratory screening investigations, was performed. Medical management included systemic steroids (4 cases), indomethacin (6 cases), a combination of the two medications (1 case), and immunosuppressive therapy (1case) Results: The main presenting symptoms were pain (12 cases) and decreased vision (9 cases). Ocular findings included chorioretinal folds (10 cases), retinal folds (7 cases), optic disc edema (9 cases), serous retinal detachment (6 cases), and subretinal mass (1 case). Ultrasonography disclosed sclerochoroidal thickening in all cases and retrobulbar edema in 7 cases. Systemic evaluation was unremarkable in 10 patients and revealed a Behçet’s disease in 1 patient, and the presence of antinuclear antibody in 1 patient. All patients showed a good response to medical treatment. Conclusion: Posterior scleritis has protean manifestations and may be easily overlooked. This diagnosis must be considered in all inflammatory and painful ocular disorders without an obvious etiology. B-scan ultrasonography is the clue of the diagnosis in such patients Financial fundings: none Conflict of interest : none Keywords: Scleritis, ultrasonography, management PO3-16-06 OCULAR WEGENER’S GRANULOMATOSIS: A CASE REPORT Niskopoulou Maria, Oueghlani Evelyne, Konstantopoulou Claire, Pavesio Carlos (Moorfields Eye Hospital) Introduction: To report a case with recurrent unilateral anterior nodular scleritis, diagnosed with Wegener’s granulomatosis, 34 months fo l l owing initial presentation. Methods: Review of records of a 49-year-old otherwise healthy man who presented with a painful, red left eye and was diagnosed with anterior nodular scleritis. He subsequently developed corneal and intraocular inflammation and was treated with topical and systemic steroids with initial resolution of the scleritis but relapses at lower doses of steroids. Results: During 34 months he had recurrent anterior scleritis but investigations including c-ANCA were consistently normal. Despite treatment with systemic immunosuppresion, visual acuity progressively decreased to hand motion. A
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Abstract Book retroorbital mass was detected on B-scan. Ocular motility of the left eye was gradually reduced leading to an almost frozen globe. MRI scan confirmed extensive orbital involvement. C-ANCA at that stage became positive and chest X-ray revealed significant pathology.
or with intraocular pressure elevation in normal rabbits’ eyes. Controlled animal studies are underway to test the efficacy of the implant in diseased eyes. Financial fundings: (None.) Conflict of interest : (None.)
Conclusion: In 8-16% of patients with Wegener’s granulomatosis, the initial presentation is ocular involvement, mostly in a non-specific manner, delaying diagnosis. With this case, we illustrate the difficulty of establishing a diagnosis in cases of limited ocular Wegener’s disease, in the absence of systemic manifestations or abnormal investigations. A systemic association should always be suspected in cases of recurrent scleritis failing to respond to conventional therapy. Repeating investigations in such cases is important in order to detect changes which will reflect the systemic nature of the condition. Financial fundings: Nil Conflict of interest : Nil Keywords: ocular wegener’s, delayed diagnosis, limited disease
PO3-17-01 25-GAUGE TROCAR FOR IMPLANTATION OF DRUG DELIVERY SYSTEMS Silva-Cunha Armando (Faculty of Pharmacy of the Federal University of Minas Gerais), Siqueira Rubens C (Retinal and Vitreous Specialized Center of the Eye Hospital of Rio Preto), Jorge Rodrigo (School of Medicine of Ribeirio Preto of the University of Sao Paulo), Fialho Silvia L (Fundaçao Ezequiel Dias/Divisio de Desenvolvimento Farmacotécnico e Biotecnologico) Introduction: The treatment of vitreoretinal diseases is limited and, nowadays, new drug delivery approaches have been reported in order to increase drug bioavailability. Intraocular implants can release the drugs directly into the posterior segment of the eye and they are able to maintain long-term vitreous concentrations of drugs within the therapeutic range. Objective: The objective of this pilot study was to investigate the short-term safety and the pharmacokinetic behavior in vitro and in vivo of a dexamethasone implant, inserted into the vitreous using a new technique that does not need surgical procedures. Methods: The drug delivery systems containing a copolymer and dexamethasone were prepared by the hot molding technique. For the in vitro study where the systems were immersed in phosphate-buffered solution and at set time intervals the medium was sampled for dexamethasone determination. In the in vivo study, the implant was inserted in rabbits’ eyes by means of a 25-gauge trocar for transcleral cannula and at different time points the vitreous was removed for drug analysis. The short-term safety was also evaluated by clinical and histological examinations. Results: The results showed that the developed device presented a prolonged release of dexamethasone within therapeutic levels, both in vitro and in vivo. Furthermore, the implant was not associated with retinal histological changes
Keywords: drug delivery system, 25-gauge trocar, dexamethasone PO3-17-02 INTRAVITREAL INJECTION OF TACROLIMUS SUPPRESSES ONGOING EXPERIMENTAL AUTOIMMUNE UVEORETINITIS IN RATS AND MODULATES NEUROTROHIC FACTOR-RELATED GENE EXPRESSION IN THE RETINA WITH EAU. Oh-i Keiko (To kyo medical unive rs i t y ) , Keino Hiroshi (Kyorin eye center), Yamakawa Naoyuki (Tokyo medical uni versity), Takeuchi Masaru (Tokyo medical university), Usui Masahiko (Tokyo medical university), Goto Hiroshi (Tokyo medical university) Introduction and objectives; Systemic administration of tacrolimus (FK506) has been shown to be effective in the treatment of refractory uveitis. Furthermore, recent papers have reported that tacrolimus exerts a powerful neuroprotective action in experimental stroke and ischemia, and on retinal ganglion cells after optic nerve crush. The current study was designed to determine whether intravitreal injection of tacrolimus suppresses ongoing experimental autoimmune uveoretinitis (EAU) in rats and modulates the gene expression of neurotrophic factor-related molecules in the retina from eyes with induced EAU. Methods; Rats were immunized with interphotoreceptor retinoid binding protein (IRBP) peptide (R14) and given intravitreal injection of tacrolimus on day 12 after immunization. As control, immunized rats received intravitreal injection of vehicle. On day 15, changes in the genetic program associated with neuroprotection and inflammatory responses in the retinas from both groups were determined by DNA microarray analyses and confirmed by RT-PCR analyses. Results; Slit-lamp examination demonstrated that mean clinical EAU scores on day 12 were 3.3 in tacrolimus-treated rats and 3.5 in vehicle-treated rats. On day 14, the mean scores were 0.5 in tacrolimus-treated rats, and 5.7 in vehicle-treated rats, indicating that intravitreal injection of tacrolimus suppressed ongoing EAU. The gene expression of inflammatory responses was markedly reduced in tacrolimus-treated eyes. Genes for molecules associated with neuroprotection (estrogen receptor, erythropoietin receptor, GABA receptor, protein kinase C, glial cell line-derived neurotrophic factor receptor, fibroblast growth factor, and neuropeptide Y receptor) were upregulated in the retinas from tacrolimus-treated eyes. Conclusions: Intravitreal injection of tacrolimus modulated the genes related to neuroprotection in the retina during the ongoing process of EAU. This treatment may be useful in both for the immunosuppression in the eyes with severe uveitis and for the neuroprotection of the retina. Financial fundings: This work was supported by Grant-in-Aid 17791258 for Scientific Research from the Japan Society for the Promotion
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Abstract Book of Science. Conflict of interest : There is no conflict of interest related to this work. Keywords: Tacrolimus, EAU, neuroprotection PO3-17-03 DEVELOPMENT OF SIMPLE CHITOSAN FILM AS DEXAMETHASONE OCULAR DELIVERY CARRIER Cunha Armando S (Federal University of Minas Gerais), Leite F Helena (Federal University of Minas Gerais), Braga G Débora (Federal University of Minas Gerais), Saliba B Juliana (Federal University of Minas Gerais), Cunha S Armando (Federal University of Minas Gerais), Faraco A G André (Federal University of Minas Gerais) Chitosan, a biodegradable and biocompatible polysaccharide, is a potentially useful material in various fields. We developed a simple chitosan film and examined the possibility of using a dexamethasone-containing chitosan film as a drug carrier for controlled release in ocular disease. The chitosan drug loaded films were produced by a casting/solvent evaporation technique. Solution of chitosan, 2 wt%, was prepared with 2 wt% acetic acid solution and distilled water. This solution was mixed with dexamethasone and was dried at room temperature for 24 h. This film was characterized initially by release studies and FT-IR. Preliminary in vitro studies at 25 oC showed that 86 % of dexamethasone was released after 24 h and 100 % was released when this study was run at 37.5 oC. The analysis in FTIR indicated that the model drug used in this work had weak hydrogen bonds with the matrix of the film. At the same time, the analysis in FTIR showed that there were no new characteristics absorption bands of drug loaded film permitting conclusion that were no obvious chemical reaction between the drug and the matrix. As an important result, dexamethasone probably did not lose its activity in the drug-loaded films. The dexamethasone-chitosan film was successfully obtained and the preliminary release tests suggest that this film is a potential carrier of sustained-release. Their release time is longer than conventional dosage forms to ocular topical delivery. Financial fundings:(None.) Conflict of interest : (None.) Keywords: Chitosan film, dexamethasone, ocular delivery PO3-17-04 B I O D E G R A DABLE IMPLANTS FOR INTRAOCULAR DELIVERY OF ANTI-INFLAMMATORY DRUGS Cunha Armando S (Federal University of Minas Gerais), Fialho L Silvia (Federal Unive rsity of Minas Gerais), Siqueira C Rubens (Retinal and Vitreous Specialized Center of the Eye Hospital of Rio Preto) Jorge Rodrigo (School of Medicine of Ribeirio Preto of the University of Sao Paulo), Cunha S Armando (Federal University of Minas Gerais) The treatment of vitreoretinal disorders has been problematic because it is difficult to gain access to the posterior seg-
ment of the eye. In order to obtain therapeutic levels over longer time periods, polymeric sustained-drug release systems, implanted into the vitreous, are being studied. The polymers derived from the lactic and glycolic acids have been the most promising ones for drug delivery systems because of their biocompatibility and biodegradation. The objective of the present study was to determine the pharmacokinetic profile of a biodegradable dexamethasone acetate implant inserted into the vitreous of rabbits and to evaluate its potential signs of toxicity to the rabbits’ eyes. Methods: A total of 60 white rabbits, divided in two groups, were enrolled in the study. The devices containing dexamethasone or the implants without drug were implanted surgically into the vitreous of the right eye of the animals of group I and II, respectively. The intravitreal drug levels were determined by a competitive enzyme-linked immunosorbent assay (ELISA). The safety of the implant was evaluated by clinical examination, electroretinography (ERG) and by light and electron microscopy. Results: The mean dexamethasone intravitreous concentration remained within the therapeutic range along the 8-week evaluation. At 8 weeks, there was still approximately 40% of the drug in the implants. Under clinical examination, there was no evidence of toxicity or media opacity in the eyes of the animals from both groups, and it was not observed increase in the pressure. There was also no evidence of retinal toxicity in both groups based on histological and ERG findings. Conclusions: Our findings showed that the dexamethasone biodegradable implant was not toxic for the normal rabbit retina and provided a sustained release of dexamethasone to the vitreous cavity 8 weeks after insertion. Further studies are needed to assure its clinical application. Financial fundings:CNPq and CAPES, Brazil. Conflict of interest :(None.) Keywords: Biodegradable implants,dexamethasone, intraocular delivery PO3-17-05 INTRAOCULAR LENS WITH DEXAMETHASONE DRUG DELIVERY SYSTEM (IOL-DDS): PHARMACOKINETIC AND TOXICITY STUDIES Silva-Cunha Armando (Faculty of Pharmacy of the Federal University of Minas Gerais), Fialho Silvia L (Fundaçao Ezequiel Dias/Divisio de Desenvolvimento Farmacotécnico e Biotecnologico), Jorge Rodri go (School of Medicine of Ribeirio Preto of the University of Sao Paulo), Ribeiro-Filho Elias (Visiontech Medical Optics Ltd), Haddad Antonio (School of Medicine of Ribeirio Preto of the University of Sao Paulo), Siqueira Rubens C (Retinal and Vitreous Specialized Center of the Eye Hospital of Rio Preto) Introduction: Untreated or protracted intraocular inflammation after cataract surgery may cause patient discomfort and contribute to several complications. Topical administration of corticosteroids is associated with low intraocular drug levels due to poor corneal penetration and elevated systemic absorption, requiring the use of highly concentrated repeated doses, which can lead to poor patient compliance and cause several adverse effects. Our group developed a new intraocular lens containing a biodegradable dexamethasone drug delivery system. Objective: To investigate the short-term safety and pharmacokinetic behavior of a new intraocular
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Abstract Book lens containing a dexamethasone drug delivery system (IOLDDS) in rabbit e yes. Methods: A modified polymethylmethacrylate IOL containing a biodegradable dexamethasone drug delivery system was implanted into the posterior chamber of rabbits’ eyes. Serial slit lamp and indirect ophthalmoscopic examinations were performed. After 3, 6, and 9 days, the rabbits were euthanized and the globes were removed for histological examination and for determination of dexamethasone levels in the aqueous humor and in the vitreous. Results: Therapeutic concentrations of dexamethasone were detectable in the aqueous and vitreous of the study eyes throughout the nine day period in all tested animals. Mean aqueous dexamethasone concentration [ng/ml (±SD)] was 1015.42 (±43.05), 970.11 (±32.47) and 757.58 (±30.19) and mean vitreous concentration [ng/ml (±SD)] was 399.82 (±38.05), 287.38 (±34.47) and 268.15 (±32.00) at 3, 6 and 9 days after the surgical procedure, respectively. No corneal or retinal histological changes were observed during the study period. Conclusion: The IOL-DDS is effective in delivering therapeutic concentrations of dexamethasone to the aqueous and vitreous, without acute damage to the cornea and retina. Further controlled studies in the same animal model are underway to determine the potential value of this lens in the prevention and treatment of inflammation following cataract surgery. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Dexamethasone, Intraocular Lens (IOL), Drug Delivery Systems (DDS), Pharmacokinetics, Toxicity
PO3-17-06 HIGH-DOSE INFLIXIMAB IN ENDOTOXININDUCED UVEITIS. Diaz-Llopis Manuel (Hospital General Unive rs i t a rio de Valencia, Spain), Udaondo Pat ricia (Hospital Genera l Universitario de Valencia, Spain), Salom David (Hospital General Universitario de Valencia, Spain), Garcia-Delpech S a l vador (Hospital General Universitario de Valencia, Spain), Hernandez-Garfella Marisa (Hospital Genera l Universitario de Valencia, Spain), Montero Javier (Hospital General Universitario de Valencia, Spain) Introduction and Objectives: Endotoxin-induced uveitis (EIU), a model of intraocular inflammation elicited by lipopolysaccharide (LPS), is a useful experimental model for understanding acute uveitis in humans and is used in studies in which the pathophysiology of this disease is examined. The objective of this study is to analyze the preventive effect of high-dose infliximab, in EIU in rabbits. Methods: An experimental study was conducted on 64 rabb i t s . Salmonella typhimurium lipopolysaccharide endotoxin was intravitreally injected. Infliximab was intravenous injected 24 hr before intravitreal injection (20 mg/kg). The animals were randomly assigned to five groups. Groups A: Saline intravitreal injection. B: Infliximab intravenous C:
Infliximab + Saline D: Intravitreal endotoxin E: Infliximab intravenous + Intravitreal endotoxin . Two masked observers, microscopic examination of aqueous humor (cells, TNF alpha) and aqueous protein level, were performed 24 hours after endotoxin injection and 48 hours after infliximab infusion. Results: Infliximab treatment, at a dose of 20 mg/kg , significantly improved all the parameters. Inflammatory cell infiltration was significantly reduced in the iris, ciliary body and anterior chamber (U Mann-Whitney test, p =0.01). Associated with lower level of TNF-alpha and protein exudate in aqueous humor (U Mann-Whitney test, p =0.01). Conclusions: Infliximab, at a dose of 20 mg/kg ,is effective in the prophylaxis of the EIU Financial fundings: (None.) Conflict of interest : The authors have no financial interest in this study Keywords: endotoxin-induced uveitis, Infliximab, rabbits, PO3-17-07 PREPARATION OF VANCOMYCIN MICROPARTICLES IN ENDOPHTHALMITIS PROPHYLAXIS : IMPORTANCE OF PREPARATION PARAMETERS LEE Miyeon (LAGEP), HACHICHA Walid (LAGEP), FESSI Hatem (LAGEP), KODJIKIAN Laurent (LBMR) Objectives: The aim of the present work was to prepare microparticles containing vancomycin for intraocular injection. Fabrication of vancomycin microparticles was optimized by using design of experiment to adjust the process parameters for optimal particle sizes. The design of experiment was also used to optimize antibiotic release profile for endophthalmitis prophylaxis. Stability and encapsulation rate were also studied, and the final fabricated particles were characterized in terms of shape, size distribution and stability. Methods: Po ly ( l a c t i d e - c o - g lycolide) micro p a rt i cles we re prepared using the double emulsion (water-in-oil-in-water) solvent extraction/evap o ration method. The influence of preparation parameters on the final microparticles properties was explored in an attempt to control particle sizes, stability, encapsulation rate and vancomycin release profile. Particle sizes were investigated using laser granulomerty. Stability was investigated by comparing the microscopic aspect (scanning electron microscopy), the zeta potential and the granulometric distribution of the particle over 2 weeks. Drug Encapsulation rate was calculated by taking into account the free vancomycin measures after breaking the particles using ultrasounds. Measurements were performed using a high performance liquid chromat ograp hy technique. Results: S atisfying release pro file and stability were obtained, independently of the process. Sizes and encapsula-
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 155
Abstract Book tion rate were controlled using an experimental design. Final obtained properties demonstrated that the fabricated particles are suitable for the prophylactic intraocular use in cataract surgery. Conclusions: A successful method for vancomycin based nanoparticles was investigated. Further in vitro and in vivo experiments will be conducted to assess efficiency of the entrapped antibacterial and then validate its potential usefulness in prophylaxis. Financial fundings: (None.) Conflict of interest :(None.) Keywords: Encapsulation, Endophthalmitis, Vancomycin, Experimental design PO3-17-08 SPECIFIC AND SUSTAINED CONTROL OF TGF BETA EXPRESSION WITHIN THE EYE BOCHOT Amélie (UMRCNRS 8612 School of Pharmacy), FATTAL Elias (UMRCNRS 8612 School of Pharm a cy ) , Gomes dos Santos Ana (UMRCNRS 8612 School of Pharmacy), Doyle Aoife (French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale, INSERM U598,), de Kozak Yvonne (French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale, INSERM U598,), Behar-Cohen Francine (French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale, INSERM U598,) I n t roduction and objective s : To ch a ra c t e ri ze antisense TGF_2-oligonucleotide (ODN)/Polye t hylenimine (PEI) complex preparation for potential transfection of retinal cells and to design microspheres combining sustained delivery and enhanced intracellular penetration for local administration of ODN. Method: The effect of medium preparation was evaluated on particle size and morphology. Cultured Lewis rat RMG cells were transfected using FITC-ODN/PEI complexes specifically directed at TGF_-2. Transfection efficacy was evaluated and regulation of gene expression was assayed. One, 24 and 72 hours after intravitreous injection of FITC-ODN/PEI complexes in rat eyes, their distribution was analyzed on eye sections.ODN/PEI complexes and naked ODN were encapsulated into poly(lactide-co-glycolide) microspheres. The efficiency of microspheres encapsulating complexes to modulate the healing process after filtration surgery on a rabbit model was investigated. Result: Complexes prepared in HBS were well calibrated and presented a core-shell structure. These particles showed a high cellular internalization efficacy, along with a significant and specific down regulation of TGF_-2 expression and production in RMG cells, correlating with specific inhibition of cell growth at 72 hours. In vivo, complexes efficiently transfect retinal cells and follow a transretinal migration at 24 hours. After 72 hours ODN seems to preferentially target
RMG cells without inducing any detectable toxicity. A marked influence of microsphere composition on porosity, size distribution and ODN/PEI encapsulation efficiency was observed. Finally, microspheres containing ODN/PEI nanosized complexes were shown to significantly improve bleb survival in a rabbit experimental model of filtering surgery. Conclusion: Specific down-regulation of TGF_-2 expression using ODN/PEI complexes may have potential interest for the treatment of retinal diseases associated with glial proliferation. Sustained release of nanosized complexes of PEI and antisense TGF-_2 ODN improves the outcome of glaucoma surgery. Financial fundings: (None.) Conflict of interest : (None.) Key wo rds: sustained re l e a s e, antisense TGF-_2oligonucleotide, nanosized complexes. PO3-17-09 ANGIOTENSIN (1-7) REDUCES INTRAOCULAR PRESSURE IN THE NORMOTENSIVE RABBIT EYE Vaajanen Anu (Institute of Biomedicine, Pharmacology, PO Box 63, 00014 University of Helsinki, Finland) Purpose: To test the effects of exogenous Angiotensin II (Ang II) and Angiotensin (1-7) (Ang 1-7) on the intraocular pressure (IOP) and on the aqueous humor dynamics in normotensive rabbit eye. Materials and methods: Male New Zealand white rabbits with normal IOP were used for intravitreal administration of the compounds. IOP was measured with pneumatonometer after topical anesthesia. Outflow measurements were done with two-level constant pressure method from anesthetized animals. Results: Ang II (5 mM) had no effect on IOP. Ang (1-7) (1mM) reduced IOP (p<0.01) during 6 hour follow-up. This effect was abolished by a selective Angiotensin (1-7) antagonist A-779, and partially by a selective angiotensin type 2 receptor antagonist PD 123,319. An angiotensin receptor type 1 blocker did not antagonize the lowering of IOP. Angiotensin II decreased outflow facility, but not Ang (1-7). Conclusion: Ang (1-7) reduces IOP possibly by a selective receptor type (Mas-receptor) without changinig aqueous humor outfl ow facility in the norm o t e n s ive rabbit eye. Grants: This study was supported by grants from The Glaucoma Research Foundation, Helsinki, Finland, The Eye Foundation, Helsinki, Finland and The Päivikki and Sakari Sohlberg Foundation, Helsinki, Finland. Financial fundings: This study was supported by grants from The Glaucoma Research Foundation, Helsinki, Finland, The Eye Foundation, Helsinki, Finland and The Päivikki and Sakari Sohlberg Foundation, Helsinki, Finland Conflict of interest :
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 156
Abstract Book Olli Oksala, Ph.D., is a director (Scientific Affairs) in Santen Oy, Finland. Keywords: IOP, Mas-receptor, Ang (1-7) PO3-18-01 UVEITIS ASSOCIATED WITH MULTIPLE SCLEROSIS Sève Pascal , Le Scanff Julie, Renoux Christel, Vukusic Sandra, Broussolle Christiane, Confavreux Christian (Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France) Introduction and objectives: Uveitis is an uncommon recognized manifestation of multiple sclerosis (MS). We conducted a study in the aim to determine the frequency of uveitis among MS patients and to compare the clinical spectrum and time course of MS in patients with or without u v e i t i s . Methods : MS patients with uveitis, identified through the Lyon MS Datab a s e, were automatically ex t racted and reviewed. Demographic and disease-related characteristics of patients with uveitis were compared to patients without uveitis from the natural history cohort. Twenty eight patients with uveitis were detected (20 relapsing-remitting MS and 8 secondary progressive MS). Results : The prevalence of uveitis in our population was 0.65%. Uveitis preceded onset of MS in 46% of the patients, it occurred simultaneously with them or after them in 18% and 36% of the cases. The topography and the timing of uveitis weren’t associated with any significant difference in MS course and prognosis. There was no difference in the course and prognosis in patients with or without uveitis. Conclusions : MS may be associated with a wide range of clinical patterns of uveitis. Patients with both uveitis and MS do not differ from others. Uveitis preceding MS onset has no specific anatomical characteristics comparing to uveitis following neurological manifestations.
ease (BD). However, central nervous system (CNS) involvements are seen frequently in patients under cyclosporine therapy. The aim of this study is to investigate the incidence of CNS involvements in patients with BD. Methods: The records of 163 patients with ocular complication in BD, who visited Tokyo Women’s Medical Hospital between Jan.2003 and May.2007, we re rev i ewed. Results: Of the 163 patients, 53 patients we re under cyclosporine therapy and 110 were treated with other medication such as colchicines. The incidence of CNS symptoms under cyclosporine therapy (14 of 53, 26.4%) was significantly higher than that of non- cyclosporine therapy (8 of 110, 7.2%) (P =0.0014). CNS symptoms occurred under cy closporine therapy with the mean dosage 3.18±1.2 mg/kg/day and after 51.3±13.6 months of administration. Systemic steroid were introduced immediately to treat neurological findings and cyclosporine were reduced or discontinued, after the onset of CNS involvement. Even after a remission of CNS involvement, neurological symptoms relapsed into five of 14 patients. All these five patients had high activity of ocular inflammation, and CNS involvements were seen within a year after the initial administration of cyclosporine. Conclusion: It becomes clear that cyclosporine increase the risk of CNS involvement for the patients with BD. We conclude it’s necessary to discontinue cyclosporine or switch to the other immeunosuppressive agents. Financial fundings: none Conflict of interest : none Keywords: Behcet’s Disease, Cyclosporine therapy, neurological manifestation PO3-18-03 ABOUT A CASE OF ATYPICAL PRESENTATION OF CEREBRAL THROMBOPHLEBITIS SZO Timea (CHI Toulon -La Seyne sur Mer), MEUNIER Isabelle (CHI Toulon -La Seyne sur Mer), Le PRINCE AnnaMaria (CHI Toulon -La Seyne sur Mer), SARFATI Eric (CHI Toulon -La Seyne sur Mer), BENHAMOU Robert (CHI Toulon -La Seyne sur Mer) Introduction : To report a case of cerebral thrombophlebitis revealed with only bilateral papillary oedema and no neurological signs.
Financial fundings: (None.) Conflict of interest : (None.) Keywords: Uveitis, Multiple Sclerosis
Methods : To review the ocular and radiological data of a 43year-old white woman with bilateral papillary oedema and unremarkable medical history (no weight gain).
Toyoguchi Mitsuko (Tokyo Woman’s Medical University ), Shimakawa Machiko (Tokyo Woman’s Medical University ), Chen Li-Li (Tokyo Woman’s Medical University ), Hori Sadao (Tokyo Woman’s Medical University )
Results : Visual acuity was 20/40 both eyes. At presentation, there were no neurological or infectious manifestations. Laboratory studies including hypercoagulable studies were normal. A cerebral computed tomography with injection disclosed no intracranial lesion. Magnetic resonance imaging and angiogram was retained due to the use of oral contraceptives and tobacco.These exams confirmed a sinus longitudinale thrombophlebitis. Under systemic anticoagulant treatment (heparin) excellent visual result was obtained.
Introduction and objectives: Cyclosporine inhibits effectively the recurrence of ocular inflammation in Behcet’s dis-
Conclusions : Cerebral Thrombophlebitis have a variable clinical presentation and ophthalmological signs can occur
PO3-18-02 THE INCIDENCE OF NEUROLOGICAL MANIFESTATION IN PATIENTS WITH BEHCET’S DISEASE
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 157
Abstract Book before any neurological manifestations.This thrombophlebitis requires an early diagnosis and treatment based on a magnetic resonance angiogram. Financial fundings: (None.) Conflict of interest : (None.) Keywords: cerebral thrombophlebitis, papillary oedema , intracranial hypertension. PO3-18-04 P S E U D OTUMOR CEREBRI SECONDARY TO DURAL SINUS THROMBOSIS IN A CHILDHOODONSET BEHÇET’S DISEASE Yilmazbas Pelin (Kirikkale Unive rs i t y, Turkey), B at i oglu Fi gen (Ankara University, Turkey ) , Yilmazbas Pelin (Kirikkale University), Ozmert Emin (Ankara University) A 13 year-old boy presenting with severe inflammatory attacks despite corticosteroids, immunosuppressives and vitreoretinal surgery in the left eye, developed papilledema in the right eye. Cerebraspinal fluid pressure was high and CT scan of the head revealed superior sagittal sinus thrombosis. Concurrently, he had an episode of erythema nodosum which led to the diagnosis of Behçet’s disease. HLA B51 was positive. Although the presenting features of childhood-onset Behçet’s disease are similar to the adult group and the diagnosis is not challenging, an increased awa reness of this disease is required in case of severe uveitis presenting with rare neurological manifestations. Financial fundings: (None.) Conflict of interest : (None.) Key wo rd s : dural sinus thrombosis, Behcet’s disease, pseudotumor cerebri PO3-18-05 OPTIC NEUROPATHY AND CHIASMOPATHY IN A SYSTEMIC LUPUS ERYTHEMATOSUS PATIENT Ö rnek Kemal (Kırıkkale Unive rsity School of Medicine Department of Ophthalmology), Güllü Reyhan (Kırıkkale Unive rsity School of Medicine Department of Ophthalmology ) , Yılmazba_ Pelin (Kırıkkale Unive rs i t y School of Medicine Department of Ophthalmology) Introduction: To report a case of optic neuropathy and chiasmopathy in a systemic lupus erythematosus patient. Methods: Case report.
Conflict of interest :(None.) Keywords: optic neuropathy, chiasmopathy, systemic lupus erythematosus PO3-18-06 SUDDEN VISUAL LOSS DURING LAMIVUDINE USE IN A CHRONIC HEPATITIS B PATIENT Yılmazba Pelin (Kırıkkale University School of Medicine Department of Ophthalmology), Örnek Kemal (Kırıkkale University School of Medicine Department of Ophthalmology), Güliter Sefa (Kırıkkale University School of Medicine Department of Internal Medicine), Onaran Zafer (Kırıkkale University School of Medicine Department of Ophthalmology), Yalçında Nilüfer (Ankara University School of Medicine Department of Ophthalmology) Introduction: To present a patient who experienced a sudden visual loss after initiating lamivudine for chronic hepatitis b infection. Methods: Case report Results: Forty three years old man suffering from sudden painless visual loss for ten days was admitted. He had chronic hepatitis b. Fundus examination revealed mild temporal pallor of the optic discs on both sides. No evidence of macular or vascular changes were observed. Patern visual evoked response was reduced on both sides. Visual field test showed a central scotoma. Optical coherence tomography and nerve fiber analysis of both eyes did not show any abnormalities. Magnetic resonance imaging of the brain and optic nerve was found to be normal. The patient was diagnosed as a possible optic neuropathy secondary to lamivudine. Lamivudine was decided to be discontinued. But his internal specialist refused to change the drug to avoid an acute exacerbation. At one month’s visit, the visual acuity was 8/10, color vision was 6/21 with Ishihara plates. Conclusions: To the best of our knowledge there is no ocular side effects of the drug reported up to now. This new and important adverse effect of lamivudine should be kept in mind before initiating a medication particularly in hepatitis b. Financial fundings: none Conflict of interest : (None.) Keywords: Lamivudine, visual loss, hepatitis b
PO3-18-07
Results: The patient was a 16 years old female. She admitted with sudden visual loss. She was receiving oral azothiopurine for systemic lupus erythematosus. On ophthalmological examination, the patient had anterior optic neuropathy. Magnetic resonance imaging showed both optic nerve and chiasm involvement. She was initiated high-dose systemic corticosteroids and continued with oral taper. Conclusion: In SLE patients, sudden visual loss may occur due to optic neuropathy and chiasmopathy. Financial fundings: (None.)
VOGT-KOYANAGI-HARADA SYNDROME IN A CASE OF MULTIPLE SCLEROSIS Montero Javier A (Pio del Rio Hortega University Hospital, Valladolid), Ruiz-Moreno M Jose (Vissum, Alicante Institute of Ophthalmology), Sanchis M Eugenia (Pio del Rio Hortega University Hospital, Valladolid), Fernandez-Munoz Marta (Pio del Rio Hortega University Hospital, Valladolid) Introduction and Objectives: To report the case of one patient with Multiple Sclerosis (MS) who experienced the u nusual association of Vogt-Koya n agi - H a rada syndro m e (VKH).
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 158
Abstract Book Methods: Clinical, Optical Coherence Tomography and Fluorescein Angiography findings. Results: A 34-year-old woman who had been diagnosed of MS two years earlier developed a progressive bilateral visual loss associated with peripapillary exudative retinal detachment with extraocular changes suggestive of VKH disease. She underwent treatment with steroids pulses and Interferon Beta 1 A, with visual acuity improvement and resolution of the retinal detachment. Conclusions: To our knowledge, this is the first published case of VKH in one patient with MS. Autoimmunity may play a major role in the pathogenesis of both entities, though the mechanisms for the development of the diseases remain unknown. Financial fundings: None Conflict of interest : None Keywords: Vogt-Koyanagi-Harada syndrome, multiple sclerosis, exudative retinal detachment PO3-19-01 “DACRYO S C I N T I G R A P H Y ” - APPLICATION OF NUCLEAR MEDICINE 99MTC-DTPA IN THE DIAGNOSIS OF NASOLACRIMAL DUCT OBSTRUCTION ( A NON INVASIVE ADVANCED RADIONUCLIDE TECHNOLOGY). Karan Peepre, Mukul Mathur, A.N.Tiwari, R.Pisal. (Gandhi Medical College,Bhopal,MP,India)
Results: Total number of cases was 11 Bilateral N L duct obstruction 02 Unilateral N L duct obstruction 08 Normal N L duct 01 It is a gold standared method,fully established & considered as method of choice in establishing correct diagnosis. Conclusions: Radionuclide Imaging of nasolacrimal duct system is a Non invasive method whereas imaging with X-ray or dacryocystography (we do a series of x-rays then a round-tipped needle is inserted into the opening of the duct and the dye(contrast) injected with pressure. It is very accurate sensitive and specific method to visualise nasolacrimal duct patency and diagnose nasolacrimal duct obstruction. Financial fundings: self Conflict of interest : Academic Key wo rds: Camera,
Dacryoscintigrap hy,99mtc-DTPA,Gamma
Introduction and Objective:
Aims:
PO3-19-02 INTRAORBITAL INJECTION OF TRIAMCINOLONE ACETONIDE IN PATIENTS WITH NON-SPECIFIC ORBITAL INFLAMMATORY SYNDROME L e i b ov i t ch Igal (Tel-Aviv Medical Center, I s ra e l ) , P rab h a k a ran Venkatesh (Royal Adelaide Hospital, Au s t ra l i a ) , Davis Garry (Royal Adelaide Hospital, Au s t ra l i a ) , Selva Dinesh (Royal Adelaide Hospital, Australia)
To enable the opthalmologist and students to understand outcome of advanced non invasive radionuclide imaging technique for successful management.
Objectives: To present a pilot study on intraorbital steroids in the management of non-specific orbital inflammatory syndrome (NSOIS).
MATERIAL AND METHODS: Dacryoscintigraphy was performed in 11 patients by dropping in conjunctival sac 1 drop of radiopharmaceutical 99mTc-DTPA, in dose 3.7-7.4 MBq (100-200 uCi). The patients head is immobilized on the support, close to detection head of gamma camera with LEHR collimater. Distribution of the RP drug was seen on the computer monitor and saved in the computer’s memory. Data,pictures was recorded and then evaluated by sight and accurate diagnosis was made.
Methods: Prospective, non-comparative, interventional case series. All patients with clinically, radiologically and histologically confirmed NSOIS, with an anteriorly located orbital mass. Patients with bilateral inflammation, blind contralateral eye, glaucoma or ocular hypertension were excluded from the study. Triamcinolone acetonide (20-40mg) was injected intraorbitally (intralesional or perilesional) in all patients. The injection was repeated at 4 week intervals if complete resolution was not achieved. Patients were assessed for local and systemic complications of steroid injection. Visual acuity, fundus examination, intraocular pressure measurement, blood pressure measurement and blood glucose levels were checked at each visit
Dacryoscintigraphy:A nuclear medicine noninvasive procedure uses unsealed ra d i o nu clide material to determine whether there is blockage in the nasolacrimal duct system or not.Small drop of a radiopharmaceutical 99mTc -DTPA is placed in corner of each eye.The patient facing a Gamma Camera and images are obtained over 20 to 50 Minutes.
Observations: Radiopharmaceutical flow was observed very carefully on the computer moniter in all the patients.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 159
Abstract Book Results: Nine patients (4 males, 5 females; mean age 51.3; range, 25-82) were treated. In 3 patients an orbital mass was noted, and in 6 patients the lacrimal gland was involved (dacryoadenitis). Significant improvement (1 case) or complete resolution (7 cases), were noted in most cases (8/9), during a follow up period of 10.5 months (range, 6-24 months). One case was non-compliant to systemic treatments and refused further interventions after a single dose of intraorbital steroids that resulted in no improvement. Conclusion: Intraorbital injection of steroid is an effective treatment modality for non-specific orbital inflammation and may be considered as a first line treatment in selected cases. Financial fundings: (None.) Conflict of interest : (None.) Keywords: triamcinolone acetonide, orbital inflammatory syndrome, orbit PO3-19-03 PARANASAL SINUS INFLAMMATION AND NONSPECIFIC ORBITAL INFLAMMATO RY SYNDROME: AN UNCOMMON ASSOCIATION Leibovitch Igal (Tel-Aviv Medical Center, Israel), Goldstein Michaella (Tel-Aviv Medical Center, Israel), Goldberg A R o b e rt (Jules Stein Eye Institute, UCLA, USA), Selva Dinesh (Royal Adelaide Hospital, Australia) Objectives: The aim of this study is to present a series of patients with orbital inflammatory symptoms associated with significant paranasal sinus inflammation and to discuss the diagnostic and management modalities. Methods: A retrospective, non-comparative, interventional case series of all patients diagnosed with orbital inflammatory syndrome and significant sinus inflammation, seen at two Orbital Units between January 1999 and October 2005. The clinical records of all patients were reviewed. Results: Of 91 cases diagnosed with non-specific orbital inflammatory syndrome, 6 (6.6%; 4 males, 2 females; mean age 5117 ye a rs) had significant sinus inflammation. Symptoms and signs were periorbital swelling and erythema, proptosis, globe displacement and ocular motility restrictions with diplopia. On imaging there was extraocular muscle enlargement and/ or orbital fat haziness, as well as almost complete ipsilateral maxillary sinus opacification with varying degrees of opacification of adjacent sinuses. Sinus biopsy in 4 cases showed a non-specific inflammatory reaction. Treatment with steroids alone (4 cases) or a combination of oral antibiotics and systemic steroids (2 cases) resulted in resolution of signs and symptoms within 24-72 hours. One case of recurrence was noted during a mean follow-up period of 9 months (range, 3-24 months), and this responded well to oral steroids. Conclusion: Although uncommon, paranasal sinusitis can be associated with a non specific orbital inflammatory syndrome. When an infectious etiology is excluded, systemic steroids may play a major role in the management of these patients and result in prompt resolution of orbital signs and symptoms. Financial fundings: none
Conflict of interest : none Keywords: Paranasal sinusitis, orbital inflammation; steroids
PO3-19-04 STUDY OF INTRALESIONAL TRIAMCENOLONE IN THE TREATMENT OF CHALAZION Yagnik Hetalkumar (New Civil Hospital,Surat), Adnani Kamla (New Civil Hospital,Surat), Naik Hetal (New Civil Hospital,Surat) INTRODUCTION AND OBJECTIVES: To evaluate the effectiveness of intralesional Triamcenolone in treating chalazion with different routes of administration and with different doses in different sizes of chalazions. METHOD: We studied total 90 patients with 100 chalazions who had attended the OPD of upgraded department of ophthalmology, New Civil Hospital, Surat. 50% cases were approached transcutaneously and 50% we re approached transconjuctiva l ly. Patients were followed up at the end of 1st week, 2nd week, 4th week, 6th week and 8th week. RESULTS: 50% patients were given injection through skin route in which 12 patients developed hy p o - p i g m e n t ation of skin. Chalazion having smaller size got 100% success with Injection Triamcenolone and with larger size, fa i l u re rates gra d u a l ly incre a s e d. Chalazion less than 6mm, 80 were resolved out of 84 which show 94. 12% success rate. CONCLUSION: This study proves intralesional Triamcenolone injection is excellent therapeutic tool for small and medium size chalazion. (i.e. <7mm size) and it is easy, effective, safe, economical and less time consuming OPD procedure compared to conventional surgery. Financial fundings: NIL Conflict of interest : NIL Key wo rd s : Triamcenolone,tra n s c u ta n e o u s ly,transconjuctivally PO3-19-05 THREE CASES OF SILENT SINUS SYNDROME Moutray Tanya N (Royal Victoria Hospital, Belfast), Fahy Colm (Royal Victoria Hospital, Belfast), Johnston Susan (Royal Victoria Hospital, Belfast), White S (Royal Victoria Hospital, Belfast), Primrose (Royal Victoria Hospital, Belfast), McKee G (Royal Victoria Hospital, Belfast) Purpose: To report the varied presentation of â&#x20AC;&#x2DC;silent sinus syndromeâ&#x20AC;&#x2122;. Methods: A retrospective case note review Results: We present 3 cases of silent sinus syndrome. The first case is a 38 year old lady who noticed a change in her facial appearance during her pregnancy, but was otherwise asymptomatic. The second case was a 38 year old gentleman who noticed some drooping of the left upper eyelid over the past fifteen months and double vision on extreme upgaze. The third case was a 34 year old lady who complained of a lid droop of new onset, associated with a sunken appearance of her left eye over the past 9 months. All three cases had radioimaging, and were treated surgically.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 160
Abstract Book Conclusion: Awareness of this condition by ophthalmologists is vital so that it can be treated appropriately, and avoid d eva s t ating functional and cosmetic complications Financial fundings: None to declare Conflict of interest : None to declare Keywords: Silent sinus syndrome, Imploding Antrum syndrome PO3-19-06 OCULAR INVOLVEMENT IN NASAL NATURAL KILLER T-CELL LYMPHOMA. Cimino Luca (Arcispedale S.M. Nuova, Reggio Emilia, Italy), Chan C Chi (National Eye Institute, Bethesda, Maryland, USA), Shen DeFen (National Eye Institute, Bethesda, Maryland, USA), Sartori Antonio (Arcispedale S.M. Nuova, Reggio Emilia, Italy), Cappuccini Luca (Arcispedale S.M. Nuova, Reggio Emilia, Italy) Introduction and Objectives: to describe the clinical, morphologic, and immunohistochemical features of a case of Paranasal Natural Killer /T-cell lymphoma (NKTL) with ocular involvement. Methods: at presentation the patient underwent a nasal computed tomography (CT) scan and multiple biopsies of the granulomatous tissue in the nasal fossae. Afterwards she had a full ophthalmic examination. After the diagnosis of lymphoma the patient underwent a bone marrow biopsy and thoracic and abdominal CT scan. An ophthalmic examination including visual acuity assessment and fundoscopic examination was made. She started chemotherapy cycles. Maxillary CT scan and ophthalmic examinations were performed during the cycles. After severe recurrences of panuveitis a diagnostic vitrectomy was performed. Results: a diagnosis of T-lymphoma cells in the vitreous was made; the tumor was most likely ori gi n ated from her paranasal Natural Killer/T cell Lymphoma. Conclusions: nasal and paranasal sinus lymphomas are rare but aggressive diseases with a tendency to invade tissues and spread to central nervous system, including eye. Ocular manifestations prior to systemic ones may be useful to monitor the response to therapy. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Natural killer T-cell lymphoma, Masquerade syndrome, diagnostic vitrectomy PO3-19-07 PEROPHERAL T-CELL LYMPHOMA CONFINED TO THE ORBIT Dongsub Lee, HaeRan Chang (kangbuk samsung hospital) Purpose: To report a case of peripheral T-cell lymphoma confined to the orbit
Methods: A 61-year old woman presented with a 2-week history of headache, dizziness, left eyeball pain and upperlid drooping. Computed tomography revealed a suble enlargement of extraocular muscle in the left orbit. Under the diagnosis of nonspecific orbital inflammation, she was treated with oral steroid. 2-month later, the patient noticed proptosis of the left eye. Follow up computed tomography of the orbit showed an enlarged extraocular muscle and an infiltrative retrobulbar soft tissue lesion in the left orbit. Incisional biopsy was performed in the orbital area. Results: Histopathologic examination showed an infiltrate of atypical lymphoid cells with degenerative muscle bundle. Immunohistochemically, these cells were reactive for the Tcell marker UCHL-1, whereas no reactivity was seen for the pan B-cell marker L26. Therefore, a diagnosis was made with peripheral T-cell lymphoma. A metastatic workup, consisting of abdominal CT, lumbar puncture and bone marrow biopsy, was performed without any evidence of extraorbital tumor. The patient was recommended to be treated with chemotherapy, but did not accept. The patient died due to progression of the disease. Conclusion: Peripheral T-cell lymphoma in the orbit is a rare case and showing an rapid clinical course. Early recognition is essential for improving the chances of survival. Financial fundings: Conflict of interest : Keywords: T-CELL LYMPHOMA, LYMPHOMA PO3-19-08 ANTERIOR UVEITIS AS AN UNUSUAL PRESENTATION OF ORBITAL INFLAMMATORY DISEASE IN AN ADULT Pang Claudine E (Singapore National Eye Centre), Teoh CB Stephen (The Eye Institute, Tan Tock Seng Hospital) Objective: To present an unusual case of orbital inflammatory disease presenting as anterior uveitis in an adult. Method: Case report Results: A 35 year-old Chinese man presented with acute anterior uveitis unresponsive to topical steroids and progressed to manifest optic disc swelling and posterior scleritis. Computed tomography imaging showed mass-like soft tissue swelling within the intraconal fat indenting the posterior medial aspect of the globe. Diagnosis of orbital inflammatory disease was made and the patient was treated with systemic corticosteroids with prompt resolution of symptoms and signs. Conclusion: Orbital inflammatory disease can present uncommonly as anterior uveitis in an adult. Financial fundings: Self Conflict of interest : None Keywords: Anterior uveitis, Orbital inflammatory disease, Pseudotumour
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Abstract Book PO3-19-09 QUANTITATIVE LACRIMAL SCINTIGRAPHY IN BEHCET’S DISEASE Yalçında F. Nilüfer (Ankara University Faculty of Medicine Department of Ophtalmology), S ü ren Elçin (Ankara Unive rsity Faculty of Medicine Department of Ophtalmology), Küçük Özlem (Ankara University Faculty of Medicine Department of Nuclear Medicine), Zilelio_lu Güler ( A n k a ra Unive rsity Faculty of Medicine Dep a rtment of Ophtalmology), Aras Gülseren (Ankara University Faculty of Medicine Department of Nuclear Medicine), Ho_al Banu (Ankara Unive rsity Faculty of Medicine Ophtalmology Department)
Monastir, Tunisia), Barkia Imen (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Je n zeri Salah (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia), Hasnaoui Wafa (Fattouma Bourguiba University Hospital, Monastir, Tunisia), Braham Darine (Fattouma B o u rguiba Unive rsity Hospital, Monastir, Tunisia) K h a i rallah Moncef (Fattouma Bourguiba University Hospital, Monastir, Tunisia)
Introduction and objective: To evaluate invivo lacrimal drainage dynamics using quantitative lacrimal scintigraphy in Behcet’s disease. To our knowledge, lacrimal drainage system functions in Behcet’s disease has not been studied before.
Methods: A retrospective study of 12 consecutive patients with orbital cellulitis, examined at the Dep a rtment of Ophthalmology of Monastir (Tunisia), from 1995 to 2006. Demographic and clinical data were analyzed.
Methods: This study included 34 eyes of 17 Behcet’s patients (10 male, 7 female with a mean age of 40.2) with no history of epiphora. Thirty two eyes of 16 healthy individuals (9 male, 7 female with a mean age of 41.3) were also included as a control group. Lacrimal drainage system was patent by irrigation in all patients and controls. Quantitative lacrimal scintigraphy was performed by a nuclear medicine specialist. The subjects were positioned in front of the Siemens gamma camera and instructed to continue blinking while 99m Tc was instilled into both eyes at the lateral canti. Dynamic scintogrames were taken immediately after instillation of the radioactive tracer and every 15 seconds for 5 minutes. Static images were also taken 5, 10, 15, and 20 minutes. Four regions of interest including inner cantus, lacrimal sac, lacrimal duct and nasal cavity for each eye are measured by computer system to obtain the flow rate and the time course in which the tracer decreases to half in outlined area of the regions. Scintogrames of all patients and controls were also evaluated to have any obstruction in the lacrimal drainage system, delaying in flow rate or stasis in the lacrimal sac. Results: There was no significant difference in the flow rate and half life of the tracer in any regions of interest between patients with Behcet’s disease and healthy controls (p>0.005). In addition, there were not any significant difference between two groups in static scintogrames until 20 minutes (p>0.005). Conclusion: These results might be attributed that Behcet’s disease does not affect lacrimal drainage system dynamics. Financial fundings: none Conflict of interest : none Keywords: lacrimal drainage system, Behcet’s disease, quantitative lacrimal scintigraphy
PO3-19-10 ORBITAL CELLULITIS: A REVIEW OF TWELVE CASES Hmidi Kamel , (Fattouma Bourguiba University Hospital,
Introduction and objectives: To analyze the clinical features, etiology, management strategy, and outcome of orbital cellulitis.
Results: The mean age at presentation was 20.2 years (range, 4 – 60 years), and 8 patients (66.7%) were male (male to female ratio = 2). Infants accounted for 66.7% of cases. Orbital cellulitis was unilateral in all cases. Fever and local edema were noted in all patients. All cases of orbital cellulitis were associated with sinusitis; ethmoid sinusitis was present in 10 patients (83.3%). Proptosis and/or ophthalmoplegia were documented in 10 patients (83.3%), and 3 patients (25%) had subperiosteal and/or orbital abscesses. Intravenous broad-spectrum antibiotics were administered to all patients. Three patients (25%) had surgical drainage. The mean duration of hospitalization was 7.6 days. The mean duration of antibiotic therapy was 21 da ys. None of the patients developed neurological complications. Conclusions: Although relatively rare, orbital cellulitis can be associated with serious complications. The prompt use of intravenous antibiotics in combination with early surgical drainage may improve patient’s outcome, and prevent irreversible visual loss. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Orbital inflammation, cellultis, proptosis PO3-19-11 CHRONIC CONJUNCTIVITIS MASQU E R A D I N G ORBITAL METASTASIS Montero Javier A (Pio del Rio Hortega University Hospital, Valladolid), Bringas-Calvo Ramon (Pio del Rio Hortega University Hospital, Valladolid), Fernandez-Munoz Marta (Pio del Rio Hortega University Hospital, Valladolid) Objective To report a case of a 52 year-old woman who had previously been diagnosed of chronic allergic conjunctivitis and presented with an orbital mass. Methods Observational case report. A complete ophthalmic workup and computerized orbit scan was performed. Clinical history was record e d.
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Abstract Book Results The patient reported history of breast cancer. Corrected visual acuity was 0.6 in both eyes. Anterior segment examination disclosed 3 mm ptosis in her right eye and a palpable mass under the upper temporal orbital rim. Slit lamp examination disclosed conjunctival injection with no further signs of ocular inflammation. There were no significant findings in fundus examination. Computerized axial tomography disclosed a 24 mm x13 mm mass in the right fossa glandulae lacrimalis without bone affection. Conclusions Unresponsive chronic conjunctivitis in a patient with clinical history of malignancy may be associated with systemic spread of the primary cancer. Financial fundings: None Conflict of interest : None Keywords: Orbit, metastasis, conjunctivitis PO3-20-01 C Y TOKINE AND MOLECULAR A NA LYSIS IN INTRAOCULAR MALIGNANT LYMPHOMA Ohta Ko u i chi (Department of Ophthalmology, Shinshu University School of Medicine) Sano Kenji (Department of Laboratory Medicine, Shinshu Unive rsity School of Medicine), Imai Hiroki (Dep a rtment of Ophthalmology, Shinshu University School of Medicine), Imai Reiko (Department of Ophthalmology, Shinshu University School of Medicine), Kikuchi Takanobu (Department of Instrumental Analysis Research Center for Human and Environmental Science, Shinshu University School of Medicine) Introduction and Objectives: The diagnosis of intraocular non-Hodgkinâ&#x20AC;&#x2122;s lymphoma (NHL) remains problematic; fa l s e - n egat ive diagnostic vitrectomies are common. Th e measurement of interleukin (IL)-10 and IL-6 levels in the vitreous and clonal heavy chain immunoglobulin (IgH) gene rearrangement have been reported as adjunctive tools in making diagnosis. We evaluated the efficacy of these cytokine and molecular analysis to support the diagnosis NHL. Methods: The diagnostic vitrectomy specimens of 6 eyes in patients with primary intraocular NHL and 2 eyes with systemic NHL were analyzed. Fourteen eyes in patients with uveitis unrelated to a neoplasm were also analyzed as control. IL-10 and IL-6 levels in the vitreous and immunoglobulin heavy chain (IgH) gene rearrangement were analyzed. Results: Malignant cells were identified in 6 eyes with NHL, while these were detected in extra ocular sites in other 2 cases. The much higher levels of IL-10 (131-7,500 pg/ml) were detected in NHL. On the other hand, the vitreous IL-10 concentrations were less than 52.7pg/ml in eyes with uveitis. Then the vitreous IL-10/IL-6 ratio was higher than 1 in NHL. The B cell monoc lonality was detected in only 5 eyes (62.5%) in NHL, but not in uveitis.
Conflict of interest : N/A Keywords: IL-10, malignant lymphoma, monoclonal gene rearrangement, PO3-20-02 DIAGNOSTIC VALUE OF BORRELIA SEROLOGY IN PATIENTS WITH UVEITIS Thiemeyer Dorothea (Universitatsaugenklinik Heidelberg), Zimmermann Stefan (Universitat Heidelberg), Max Regina (Rheumat o l ogie d. Univers i t at Heidelberg) Becker D Matthias (Unive rs i t at s a u genklinik Heidelberg) Mackensen Friederike (Universitatsaugenklinik Heidelberg) Introduction and objectives: As a standard all our Uveitis patients who present to our clinic for the first time undergo testing for Borrelia burgdorferi sensu lato. Southern Germany is a region where approxim at e ly 15% of ticks are positive for this spirochete. No agreement, though, exists, which clinical presentation of uveitis would be correlated to Borreliosis. Therefore we wanted to review all our patients with a positive serology and see if a uveitis pattern could be seen. Methods: A computer search was performed for all patients where serology for Borrelia subspecies was ordered from January 2003 to date. Elisa results for IgG and IgM were recorded. Positive Elisa results were confirmed by Western blot testing using a commercial kit. Number of positive bands in Western Blot IgG or IgM assay were counted and probability of diagnosis determined. Results: We ordered sero l ogy testing for 258 patients. Out of these, 6 were positive for Borrelia (IgG = 5, IgM =1) in Elisa, but negative in Westernblot, showing an unspecific reaction to spirochetal antigens. 25 (9.7%) were positive in Elisa and Westernblot testing Of these, seven Patients had > 5 bands in Western Blot and were thus given highest probability of a correct diagnosis. Nine patients had 3-4 bands (= median probability), nine patients only showed 1-2 bands (= low probability). In the group with a high pr obability for a Borrelia associated Uveitis, no Uveitis subtype prevailed: 1 scleritis, 1 anterior, 2 intermediate, 1 posterior and1 panuveitis. 1 patient had no uveitis at all. Conclusions: Serology results for Borrelia burgdorferi sensu lato has to be interpreted with caution. We could not see a correlation of a positive serology confirmed by western blot to one uveitis subtype in our cohort. The usefulness of determining serology for borrelia in all uveitis patients has to be discussed. Financial fundings: no Conflict of interest : i can disclose any potential conflicts of interest Keywords: diagnostic value of borrelia serolgy
Conclusion: The measurement of vitreal IL-10 is more useful than gene rearrangement as adjunctive tool. Financial fundings: N/A 9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 163
Abstract Book PO3-20-03 AQUEOUS FLARE AND CELLS IN FUCHS SYNDROME Fang Wang (1State Key Lab o rat o ry of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China;) Zhou Hongyan (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China;) Yang Peizeng (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China;) Huang Xiangkun (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China;) Wang Li (1State Key Laborat o ry of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China;) Kijlstra Aize (2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China; 3Eye Research Institute Maastri ch t , Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands) Objective: To quantitatively evaluate aqueous flare and cells in patients with Fuchs syndrome. Methods: The medical records of 40 patients (47 eyes) diagnosed with Fuchs syndrome between February 2006 and January 2007 at the Uveitis Study Center of Sun Yat-sen University were retrospectively reviewed. Aqueous flare and cells were clinically evaluated and quantified with laser flarecell meter. Statistical analysis was performed to investigate the relationship between flare values and cell counts and clinical parameters including patients’ age, sex, duration of disease, best-corrected visual acuity, keratic precipitate, iris depigmentation, intraocular pressure and posterior subcapsular lens opacities. Results: Aqueous flare values (photon counts/ms) were significantly higher in Fuchs syndrome (9.40±5.85) than in normal controls (5.77±1.89, P=0.000). Aqueous cell counts (cells/0.5mm3) were also significantly higher in Fuchs syndrome (5.09±4.84) than in normal controls (1.14±1.03, P=0.000). The flare values were positively correlated with the cell counts (r=0.331, P=0.001). Both flare values and cell counts were higher in eyes with keratic precipitates scored 2+ or 3+ as compared to those with a 1+ score. Higher flare values and cell counts were also observed in eyes with a 2+ or 3+ iris depigmentation score as compared to those with a 1+ score. No difference was found between flare values and cell counts and other parameters.
Conclusion: Breakdown of blood-aqueous barri e rs and increased cell counts are present in the affected eyes in patients with Fuchs syndrome. These changes are positively associated with the degree of keratic pr ecipitates and iris depigmentation. Financial fundings:This study was supported in part by the Fund for Project of Science and Technology of Guangdong province (2005B60302009), Key Project of Natural Science Fo u n d ation (30630064), N ational supporting project of P.R.China and “5010” Clinical Project of Sun Yat - s e n University. Conflict of interest : None of the authors has a proprietary or financial interest in any product mentioned. Keywords: Fuchs syndrome, laser flare cell photometry, blood-aqueous barrier
PO3-20-04 A CASE OF TOXOCARA RETINOCHOROIDITIS ASSOCIATED WITH THE PORCINE ASCARIDS DIAGNOSED BY ANTIBODIES IN THE SUBRETINAL FLUID M at s u yama Kaya ko (Kansai Medical Unive rsity Takii Hospital), Ogata Nahoko (Kansai Medical University Takii Hospital), Kimoto Takashi (Kansai Medical University Takii Hospital), Takahashi Kanji (Kansai Medical University Hirakata Hospital), Matsumura Miyo (Kansai Medical University Hira k ata Hospital) N i s h i mu ra Tetsuya (Kansai Medical University Takii Hospital) Purpose: The clinical diagnosis of ocular toxocariasis is made by specific immunotests that show elevated titers of antibodies. However, the tests may be negative in serum because the toxocara antigens may be localized. We report a case of chorioretinal toxocariasis associated with porcine ascarids diagnosed by antibodies in the subretinal fluid. Case: A 45-year-old man presented at another hospital with increased visual disturbances of the left eye of 2 months duration. He was diagnosed with uveitis and was treated with topical steroids for 1 month. He was told that he had bilateral hilar lymphadenopathy after a routine health check 6 months earlier and was diagnosed as having sarcoidosis. However, he appeared healthy and did not have clinical symptoms of sarcoidosis systemically and ocularly. On his first visit, his visual acuity was 20/20OD and 8/20OS.The anterior chamber and vitreous of his left eye were mildly inflamed, and a yellowish-white exudate with a retinal d e t a chment was present in the lower peri p h e ral retina. L ab o rat o ry ex a m i n ation was almost normal. After two weeks, the vitreous opacities increased, and the exudative retinal detachment worsened and affected the macula. Pars plana vitrectomy and silicon oil replacement were performed. During the surgery, ocular samples were collected for further examinations.
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Abstract Book Results: Elevated titers of specific antibodies against porcine ascarids were detected only in the subretinal fluid and not in the aqueous humor, vitreous, or serum. Systemic anthelminthics and steroids were begun, and the ocular inflammation resolved. Three months later, the retina was attached and his visual acuity had improved to 20/30. Conclusions: These results demonstrate the importance of testing ocular fluids in cases of uveitis of unknown cause. Vitrectomy with the collection of ocular samples, especially subretinal fluid, was a key for the diagnosis of toxocara retinochoroiditis associated with the porcine ascarids. Financial fundings: (None.) Conflict of interest : (None.) Keywords: serous detachment,porcine ascarids,subretinal fluid
of no trauma, the probability of a foreign body should always be kept in mind. Conclusion Pathologic evaluation of intraocular fluids should be carried out in patients with refractory uveitis to identify the etiology. Financial fundings: no funding Conflict of interest : (None.) Keywords: malignacy, trauma,pathology PO3-20-06 ETIOLOGIC DIAGNOSIS OF UVEITIS AFTER OCULAR TRAUMA Gueudry Julie, Terrada Céline, Ducos Ghislaine, Fardeau Christine,, Le Hoang Phuc,, Bodaghi Bahram (Dept of Ophthalmology, University of Pa ris VI PitieSalpetriere Hospital, Paris, France ) Introduction and objectives: Etiologic diagnosis of uveitis occurring after ocular trauma remains a challenge to adapt therapeutic strategies.
PO3-20-05 IS IT UVEITIS; MALIGNANCY OR FOREIGN BODY? Altan Simge, Soylu B. Merih, Yar Kemal (Çukurova University)
Methods: We examined, between November 2006 and April 2007, 10 patients with chronic unilateral or bilateral uveitis after either surgical or accidental trauma to one eye. An extensive work-up was performed.
Introduction Etiological and differential diagnosis is not easy in all uveitis cases. In some cases diagnostic tests are not sufficient, in whom pathological evaluation of intraocular specimens help us to make the correct diagnosis.
Results: Five patients presented an anterior uveitis and five patients presented a panuveitis. Two patients were diagnosed with presumed sarcoidosis. The diagnostic wo rk-up remained negative in 80% of patients and they were treated as sympathetic ophthalmia.
Methods In the present study 2 cases with uveitis are presented in which the etiology couldn’t identified by routine laboratory work-up First case was a 53 y/o male, who had no history of systemic or ocular disease, presented with acute anterior uveitis which occurred after chemical trauma..He had refractory uveitis that didn’t respond to medical therapy. After long-term follow-up and laboratory work-up, including AC paracenthesis and vitreous biopsy the case was diagnosed as ocular metastasis of lung carcinoma. Despite of chemo- and radiotherapy the patient died one year after the diagnosis. The second case was a 11 y/o male who presented with sudden loss of vision. He had anterior uveitis, heterochromia and dense vitritis that obscured fundus details. He had no history of trauma or systemic disease. The patient was diagnosed as idiopathic panuveitis. In the laboratory work-up a suspected foreign body was detected in CT. PPV combined with lensectomy was performed. A nevus-like lesion was seen in the peripheric retina. Pathologic evaluation of vitreus revealed a foreign body, with profound histiocytes and melanin granules. His vision is improved after surgery.
Conclusion: Results suggest that sarcoidosis must be researched in this situation and that sympathetic ophthalmia may be suspected even in anterior uveitis.
Results Ocular metastasis could be the initial manifestation of lung cancer. It should be considered in the differential diagnosis of refractory uveitis occurring after trauma. Also in patients with severe refractory uveitis, especially in children, despite
Financial fundings: NONE Conflict of interest : NONE Keywords: ocular trauma, uveitis, sympathetic ophthalmia PO3-20-07 CONTRIBUTION OF THE LABORATORY TO THE DIAGNOSIS OF INTRAOCULAR TOXOPLASMOSIS AND HERPESVIRUS TRIGGERED UVEITIS: REALTIME POLYMERASE CHAIN REACTION AND DETERMINATION OF INTRAOCULAR ANTIBODY PRODUCTION ERRERA M-H (Service d’Ophtalmologie IV, C e n t re Hospitalier National d’Ophtalmologie des Quinze-Vingts, Paris), BATELLIER L (Lab o rat o i re de Biologi e, Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, Paris), GOLDSCHMIDT P (Laboratoire de Biologie, Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, Paris), SAHEL J-A (Service d’Ophtalmologie IV, Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, Paris), CHAUMEIL C (Laboratoire de Biologie, Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, Paris)
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Abstract Book Introduction and objectives : To determine the predictive diagnosis capacities of the realtime polymerase chain reaction (PCR) and the determination of intraocular specific antibody secretion (Goldmann-Witmer coefficient) on aqueous humors and vitreous samples for the etiological diagnosis of viral (HSV, VZV, CMV) and ocular toxoplasmosis triggered uveitis. Methods : From January 2005 to August 2007, aqueous humor and vitreous samples were collected from patients suspected of u veitis (ocular toxoplasmosis or viral uveitis : HSV,VZV,CMV) in the Centre Hospitalier National d’Ophtalmologie des XV-XX. The intraocular antibody secretion was assessed by the Goldmann-Witmer coefficient and/or the detection of the herpes viruses or toxoplasmic genome by real-time PCR. The specific IgG of paired aqueous humor/serum samples was quantified by immu n o fl u o rescence (toxoplasmosis, HSV, VZV) or by immunoenzymatic technique (CMV) and the total IgG (g/l) was determined by nephelemetry. Results: During 2006, 124 intraocular specimens were analyzed and 22 positive results (18%) were obtained : 11 for herpes virus and 11 for toxoplasmosis. Some were positive for both GWC and PCR, others were positive for either GWC or PCR. All positive and negative results were correlated to the clinical signs, the evolution of uveitis, the degree of local inflammation and the time of sampling after onset of ocular disease. This present study is carried out since January 2005 and will be concluded in August 2007. Conclusions
:
The preliminary analysis of the data indicates that both PCR and GWC determination are techniques that have to be performed for a comprehensive diagnosis of viral or toxoplasmosis triggered uveitis. Considering the low volume of humor aqueous samples, the discussion between the clinicians and the lab teams based on the clinical information and the best test to perform according to onset of signs and predictive value of each test should improve the quality of the diagnosis. Financial fundings: (None.) Conflict of interest : (None.) Keywords: intraocular toxoplasmosis and herpesvirus triggered uveitis, real-time polymerase chain reaction, determination of intraocular antibody production.
PO3-20-08 EVALUATION OF NEOPTERIN LEVELS IN AN ENDOTOXIN INDUCED EXPERIMENTAL UVEITIS MODEL IN RABBIT EYES S e rif Nigar (Gazi Unive rs i t y, Faculty of Medicine- Ankara,
TURKEY) Gurelik , Gokhan (Gazi University, Faculty of MedicineA n k a ra , TURKEY), Yaman Halil (Gulhane Medical Faculty, Ankara, TURKEY), Akyurek Nalan (Gazi University, Faculty of Medicine- Ankara, TURKEY), Hasanreisoglu Berati (Gazi University, Faculty of Medicine- Ankara, TURKEY) Introduction: In this study neopterin levels of intraocular fluids and serum were analyzed in the endotoxin-induced uveitis model. Methods: To produce endotoxin-induced anterior uveitis model, 0.05 ml E.Coli lipopolysaccharide have been injected into the right eyes of 14 rabbits while left eyes have been evaluated as control group. From 7 rabbits in the first group aqueous fluid, vitreous and serum samples were drawn in the 24th hour while from the other 7 in the 2nd group samples were drawn in the 72th hour. Total protein and neopterin levels of these samples were measured by HPLC method. Simultaneously, eyes were bila terally enucleated and uveitis induced histopathological changes were examined. Results: Mean levels of neopterin in serum, aqueous fluid and vitreous were 4.02±1.6, 29.32±6.25, and 18.84±6.35 respectively in the 24th hour samples. In the 72th hour samples mean levels were 1.39±0.4 in serum, 7.30±5.20 in aqueous fluid and 55.16±31.11 in vitreous and difference between two groups were statistically significant (p=0.001). Total protein levels were also parallel with neopterin. Histopathologic evaluation revealed that in the first 24 hour inflammation is significant in choroid and ciliary body and in 72 hour it is significant in retina. Conclusion: This study demonstrates neopterin level and activity correlation in the early and late stages of inflammation. Financial fundings: (None.) Conflict of interest : (None.) Keywords: uveitis, neopterin, HPLC
PO3-21-01 BILATERAL CYTOMEGALOVIRUS ARTERITIS IN A HIV POSITIVE INDIVIDUAL Murthy Krishna R (Vittala International institute of ophthal mology & Prabha Eye clinic and Research center, Bangalore), Babu Kalpana (Vittala International institute of ophthalmology & Prabha Eye clinic and Research center, Bangalore), Sridharan Sudarshan (Medical Research foun dation, Chennai), Biswas Jyotirmoy (Medical Research foun dation, Chennai) Purpose: We report a case of bilateral cytomegalovirus arteritis in a human deficiency virus (HIV) positive individual receiving highly active antiretroviral therapy (HAART) Design: Retrospective, interventional case report Results: A 39-year-old HIV positive male with a cd4:cd8 ratio of 0.10 (normal range:0.70-2.58) presented with diminution of vision in both eyes of 1-month duration. Fundus examination revealed bilateral arteritis and sheathing of arteries. The veins were unaffected. A patch of retintis was noted only in the right eye. Fundus fluorescein angiogram revealed areas of capillary nonperfusion in both eyes. The right eye showed macular ischaemia in addition. Polymerase chain reactions on the aqueous were positive for cytomegalovirus in both eyes and negative for other infections. Inspite of systemic and multiple intravitreal ganciclovir injections, the right eye progressed very rapidly to neovascularisation, vitreous haemorrhage and neovascular glau-
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Abstract Book coma resulting in no perception of light. Segmentation and recanalisation was noted in the left eye. He underwent pan laser photocoagulation in the left eye. Over 2 months, he developed immune recovery uveitis in the left eye and received valganciclovir and oral steroids. At the end of 7 months, vision and ocular condition in the left eye is stable. Conclusion: This case highlights a rare presentation of bilateral arteritis due to cytomegalovirus resembling a frosted branch with noninvolvement of veins. The early intervention is highlighted in the management of this rare condition. Financial fundings: none Conflict of interest : nil Keywords: HIV, ARTERITIS, CYTOMEGALOVIRUS
PO3-21-02 OPHTHALMIC MANIFESTATIONS AS THE PRESENTING SIGN OF HIV INFECTION Gharai Sujit (Dr Rajendra Prasad Centre for Ophthalmic Science, AIIMS, New Delhi, India.), Venkatesh Pradeep ( Dr Rajendra Prasad Centre for Ophthalmic Science, AIIMS, New Delhi, India.), Garg Satpal ( Dr Rajendra Prasad Centre for Ophthalmic Science, AIIMS, New Delhi, India.) Objectives: To evaluate the incidence of HIV infected patients who present only with isolated ophthalmic manifestations as the initial presenting sign of HIV infection Methods: Retrospective evaluation of the consecutive 135 HIV infected patients enrolled in between September 2004 and September 2006 at the apex centre in India. Results: 7 % (n=9) HIV infected patients present only with ophthalmic manifestation as the initial presenting sign of HIV infection. Of them 56% (n=5) patients were in category C i.e. AIDS indicator conditions. The mean and median ages were respectively 31.56 yrs and 32 yrs. About 2/3rd patients were in 4th decade of age. The most common was CMV retinitis (33%).Other manifestations included CRVO (n=2), ARN syndrome (n=1), optic neuropathy (n=1), isolated incongruous homonymous hemianopsia due to tubecular cerebral abcess (n=1), herpetic anterior keratouveits with complete ophthalmoplegia (n=1), and peripheral ulcerative keratitis (n=1). Conclusions: HIV infected patients may present with atypical ophthalmic manifestation as initial presentation of HIV infection. This highlights the need for increased index of suspicion for HIV infection in young patients with atypical ophthalmic condition. So, ophthalmologists have an important role in diagnosis and screening of HIV infection. Financial fundings: nil Conflict of interest : none Keywords: HIV, initial manifestations, ophthalmic manifestations
PO3-21-03 DIFFERENTIAL DIAGNOSIS BETWEEN TOXOPLASMIC AND TUBERCULOUS RETINOCHOROIDITIS: A CLINICAL CASE Rodriguez Laura (Ophthalmology Unit - Padua University Italy), De Dominicis Chiara (Ophthalmology Unit - Padua University - Italy), Tognon Sofia (Ophthalmology Unit Padua University - Italy) Introduction and objectives: To describe a difficult differential diagnosis between toxoplasmosis and tuberculosis, in a patient with endophtalmitis sustained by an active focal choroiditis. Methods: A 59- years- old immunocompetent male, presented with acute panophthalmitis in left eye. When the anterior and vitreal inflammation reduced, ophthalmoscopy revealed a choroidal focal lesion associated with retinal arteritis. The patient underwent a complete infectivology and immunological wo rk-up who was significat ive for a recent Toxoplasmosis infection (specific IgM and IgG antibodies with low avidity ) but also for a secondary extapulmonary active tuberculosis, with Mantoux skin test > 20 mm, Quantiferon test positive (evidence of latent tuberculosis ), Chest X ray with old primary complex but sputum negative for BK.. Results: Acquired acute sistemic toxoplasmosis in adult age is rarely associated with chorioretinal lesions , perifocal arteritis is not tipical of toxoplasmosis but is possible in ocular tuberculosis, the choroideal lesion of our patient had clinical evidence of a typical tuberculoma. Vitreous humor subjected to polymerase chain reaction (PCR) for Toxoplasma and Mycobacterium tuberculosis was negative, unfotunately, PCR has a hight specificity but a low sensitivity when performed in acqeous and vitreous humor. Conclusions: The differential diagnosis between toxoplasmic and tubercular retinochoroiditis is important in order to start a correct treatment; in fact, the multidrug antitubercular chemotherapy is a long term therapy, and it is effective if rapidly start. Both infections have tropism for the chorioretina and the differential serological diagnosis may be difficult in Italy where seroprevalence of Toxoplasma is almost 60%, and recently there is a strong increase of tuberculosis. In our patient we can suppose that the toxoplasmic recent infection incited the ocular expression of latent tubercular infection with evidence of a classic tuberculoma; moreover, the severe endocular inflammation with retinal arteritis, vitreitis and anterior chamber reaction, suggests a complex immunological iperergic etiology. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Differential diagnosis, Toxoplasmosis, Tuberculosis
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Abstract Book PO3-21-04 HTLV- I ASSOCIATED UVEITIS AND OTHER HTLVI ASSOCIATED DISORDERS Maruyama Koichi (Department of Ophthalmology, Kinki University School of Medicine), Arimura Eiko (Department of Ophthalmology, Sakai Hospital Kinki University School of Medicine), Takada Sonoko (Department of Ophthalmology, Kinki University School of Medicine), Matsumoto Chota (Department of Ophthalmology, Kinki University School of Medicine), Shimomu ra Yoshikazu (Department of Ophthalmology, Kinki University School of Medicine) Introduction and Objectives: Human T-lymphotropic virus type I (HTLV- I) is known as an important virus in the pathogenesis of HTLV- I associated uveitis (HAU). Because HTLV-I can also cause other disorders such as HTLV- I associated myelopathy and bronchopneumopathy, we aimed to investigate the clinical manifestations of HAU and other HTLV- I associated disorders. Methods: Clinical and laboratory evaluations, including ocular findings and serum HTLV- I antibody titer, were carried out on ten patients with HAU. In addition, measurement of cerebrospinal fluid HTLV- I antibody titer and neurologic examination were performed on three patients who had s h own some subjective neurologic symptoms. Transbronchial lung biopsy (TBLB) for histological findings was also conducted on three patients with abnormal results of chest computerized tomography (CT). Results: Results of the clinical and laboratory evaluations indicated iritis, vitreous opacity, and periphlebitis in all ten patients and increased levels of serum antibody ranged from 1:128 to 1:65536. Three patients who had received neurologic inspections had episodes including hyperreflexia of deep tendon reflex. Their levels of cerebrospinal fluid HTLV- I antibody titer also increased to either 1:64 or 1:256. TBLB revealed subepithelial ly m p h o cytic infi l t ration of the bronchial wall in two of the three patients and interstitial lymphocytic infiltration of the alveolus in the other patient. Conclusions: In case of HTLV- I infection, we consider that not only ocular examination and serological test but also systemic examinations for neurologic and pulmonary complications should be performed. Financial fundings: (None.) Conflict of interest : (None.) Keywords: HTLV- I associated uveitis, myelopathy, bronchopneumopathy
PO3-21-05 SEROUS RETINAL DETACHMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS Lam Wai-Ching, Adatia Fiesal (University of Toronto) Introduction: Systemic Lupus ery t h e m atous(SLE) is an immune mediat e d multi-system disease, in wh i ch the eye is commonly involve d. S e rous retinal detachment(RD) are uncommon, we pre s e n t t h ree cases of serous RD with diffe rent manife s t ations and etio l ogies. Recognition of clinical ch a ra c t e ristics and the ophthalmic findings can help tailor tre atment and alert clinicans as to when SLE ch o ro i d o p at hy can potentially be fat a l .
Methods: Case series of 3 SLE patients presented consecutively with serous retinal detachment. Patients underwent ocular examination, IVFA, ICG angiography, OCT, and B scan evaluation where appropriate. Results: The etiology of the 3 cases were: SLE choroidopathy, effusion retinal detachment due to SLE nephropathy and classic central serous retinopathy. Combination of immunosuppressive agents, oral and subtenon steroids were succcessful in treating the systemic SLE manifestions as well as the ocular SLE choroidopathy in one patient. A second patient with both pleural and pericardial effusion, secondray to SLE nephropathy improved with resolution of the systemic effusion. Our third patient had classic CSR and resolved with time Conclusion: C a reful attention to clinical pre s e n t ation, FA, and ICG angiography can help to determine treatment modalities and alert clinicans to when SLE choroidopathy can be life threatening. Serous retinal detachments in SLE can have varied etiology, therefore tailor treatment is essential. Financial fundings: none Conflict of interest : none Keywords: retinal detachment, systemic lupus erythematosus,nephropathy PO3-21-06 TNF - ALPHA BLOCKERS - A WORKING THERAPY OPTION IN COGAN SYNDROME Hochwarter Anelia, Binder Susanne (Rudolf Foundation Hospital, Vienna and Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery, Vienna) Coganâ&#x20AC;&#x2122;s syndrome is characterized by vestibulo-auditory symptoms and intestinal keratitis or ocular inflammation, such as uveitis, scleritis, conjunctivitis, retinal vasculitis, myositis, papillitis. We report the case of a 84-years old male, who consulted initially for hearing loss in the right ear, 16 months later for vestibulo-auditory deficits in the left one, and two months later was affected in both eyes with anterior uveitis, superficial keratitis and posterior uveitis with retinal and choroidal detachments. Therapy with high dosis of intravenously corticoids was not effective. Five days later treatment with anti-TNF-alpha was started, leading to a rapid clinical and functional remission. Therapy with TNF-alpha-blocke rs leads to signifi c a n t improvement of the symptoms of Cogan syndrome. Financial fundings: (None.) Conflict of interest :(None.) Keywords:TNF - Alpha Blocker , Cogan Syndrome
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Abstract Book PO3-21-07 ULTRASOUND EXAMINATION IN DETECTING AIDS PATHOLOGY IN THE EYES Loresa Kriauciuniene (Kaunas Medical University), Antanas Gumbelevicius (Kaunas Eye Clinic) Introduction and objectives: Ultrasound B scan is an important diagnostic method in eye pathology. We want to demonstrate the usefulness of ultrasound B scan in early diagnosis of AIDS symptoms and structural changes in the eyes. 30 year female with bilateral vitreitis was examined. Patient had suddently unilateral loss of vision acuity. Methods: Patient undergo full oftalmological examination and ultrasound B scan diagnostic examination. Results: During 2 weeks patient noticed sudden loss of vision acuity. Slit lamp examination revealed acute anterior uveitis. Fundus examination revealed pathological findings of toxoplasmotical chorioretinitis. Ultrasound B scan diagnostic examination revealed hard changes in vitreous body. In right eye we diagnosed vitreitis and in left eye was more intensive changes of endophthalmitis. During systemic treatment of toxoplasmosis and AIDS in right eye we noticed full process stabilization. Acute retinal necrosis and full loss vision we noticed in left eye. Ultrasound B scan revealed only structural changes of vitreous in right eye and vitreous hemorages and total retinal detachment in left eye. Conclusion: We recommend early referral of cases of AIDS pathology in the eyes for baseline Ultrasound scan and follow up scan in 2 weeks, 4 weeks, 3 months and for later time to detect underlying pathology. Financial fundings: (None.) Conflict of interest : (None.) Keywords: Ultrasound, AIDS, retina necrosis
PO3-21-08 MACULAR HAEMORRHAGE IN DENGUE FEVER El-khashab Tarek A ly (Leighton Hospital), Job A Raly (Leighton Hospital), Lavin M Mike (Manchester Royal Eye Hospital) A 29 years old lady presented with decreased vision following a world tour she was found to have macular haemorrhage associated with fever investigation confirmed Dengue fever . Macular haemorrhage in a young person who suffers from fever and with travel history specially to southeast Asia should be fully investigated .
PO3-21-09 MASQUERADE SYNDROME FROM CUTANEOUS MELANOMA METASTASIS Lee Cheryl P L (Bristol Eye Hospital,United Kingdom), Fardeau Christine (Hopital Pitie-salpetriere,Paris), Cassoux N atalie (Hopital Pitie-salpetri e re, Paris), LeHoang Phuc (Hopital Pitie-salpetriere,Paris) Introduction and objective s : Metastasis of cutaneous melanoma into the eye is a very rare event with only 67 cases being reported over 112 years from 1885 to 1996. We present two interesting cases that presented with uveitis as a masquerade syndrome. Fluorescein angiogram (FFA), indocyanine green angiogram (ICG) and optical coherence tomography descriptions are reviewed. Methods: Two patients with previously surgically excised cutaneous melanoma and known brain metastasis we re referred for management of persistent inflammation with unilateral uveitis at Pitie Salpetriere Hospital. All routine investigations carried out to exclude common causes of uveitis were normal. Vitrectomy for cytology and immunocytochemistry were confirmatory for the diagnosis of metastasic melanoma to the eye. Clinical, angiographic, echographic, optical coherence tomography features are documented. Results: Both patients were male and 65 years of age with cutaneous melanomas on the leg which was excised. Two ye a rs later both developed metastasis to the brain and received chemotherapy. Both were in remission when one presented with non pigmented vitreous cells and the other with vitritis as well as choroidal infiltration around the optic nerve head. In both cases indocyanine green revealed subclinical choroidal involvement in the posterior pole. OCT revealed serous retinal detachment. A vitreous biopsy disclosed a metastatic intraocular melanoma that was positive for vimentine and PS 100. Both patients were managed with Muphoran and intravitreal triamcinolone. Both patients succumbed to their primary disease and died 8 and 11 months after the begining of Muphoran treatment. Conclusion : Uveitis can present a diagnostic challenge. It is often the sole initial manifestation of an occult systemic problem. Treatment-resistant uveitis should raise the suspicion of an infectious or malignant masquerade. Angiographic tests are essential in diagnosis of subclinical choroidal metastasis of cutaneous malignant melanomas. Financial fundings: NONE Conflict of interest : NONE Keywords: METASTASIS,MELANOMA,ICG
Differential diagnosis and management will be presented Financial fundings: None Conflict of interest : None Keywords: Macular Haemorrhage , Dengue fever
PO3-21-10 DIFFERENTS PRESENTATIONS OF OPHTHALMIC ASPERGILLOSIS Willermain Franรงois (CHU St-Pierre, Bruxelles, Belgium), Bradstreet Christophe (CHU St-Pierre, Bruxelles, Belgium), Kampouridis Stelianos (CHU St-Pierre, Bruxelles, Belgium), Libert Jacques (CHU St-Pierre, Bruxelles, Belgium), Koch Philippe (CHU St-Pierre, Bruxelles, Belgium), C a s p e rs Laure (CHU St-Pierre, Bruxelles, Belgium)
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Abstract Book Introduction and objectives: To describe three patients with different ophthalmic lesions due to aspergillus. Case reports: All patients were women. The first was treated with methylprednisolone (MPS) for autoimmune hepatitis. She complained of blurred vision in her right eye. Slit lamp examination revealed an uveitis with hypopyon and a barely visible fundus. A systemic work-up revealed pulmonary and brain lesions compatible with the diagnosis of disseminated aspergillosis. Immunologic testing was positive for aspergillus. Her general status degraded rapidly and she died despite systemic and intravitreal antimycotic therapy. The second patient had a history of systemic sarcodosis and developed a right optic nerve lesion with optic nerve edema. The mass was unresponsive to high dose MPS. A biopsy was performed and showed aspergillus fumigatus. She responded poorly to different antimycotic therapies and the lesion invade the chiasma. The patient progressively lost her visual acuity and visual field till no light perception. The third patient had a history of severe graft versus host disease after bone marrow transplantation for acute leukaemia and was treated for several months with high doses MPS. She presented for acute bilateral visual loss. Visual acuity was no light perception in both eyes. Many cells were present in the anterior chamber and the vitreous. The fundus was hardly visible but showed areas of retinal detachment and strong vascular sheatings. A systemic work-up demonstrated pulmonary and brain lesions with a positive immu n o l ogic testing fo r aspergillus. Vitreous specimen collected during vitrectomy showed the presence of aspergillus. No visual acuity could be saved despite intense antimycotic treatment. Conclusions: Our cases illustrate that ophthalmic aspergillosis can present acutely with a devastating intraocular inflammation or more indolently in the setting of sino-orbital aspergillosis. Both forms have a bad visual prognosis and the systemic one is frequently associated with a fatal outcome. Financial fundings: None Conflict of interest : None Keywords: Aspergillosis, endophthalmitis, intraocular inflammation
PO3-21-11 THE CASE FOR SARCOIDOSIS IN WOMEN OLDER THEN 65 YEARS OLD Neumann Ron Introduction: Presented will be three cases of women above the age of 65 years old who were diagnosed with uveitis associated with sarcoidosis. Methods: A retrospective case series Results: Three women in their 7th decade, all presented with
panuveitis. Sarcoidosis was diagnosed either before or following first episode of uveitis, and all had subclinical pulmonary disease at the time of uveitis activity. Their clinical courses was favorable. These data will be critically reviewed in reference to the ophthalmic literature. Conclusions: Elderly patients do present with pri m a ry uveitis. Among elderly women, sarcoidosis is probably the most common single diagnosis. While ACE and chest CT are extremely useful diagnostic tools, high level of suspicion is the main clue for diagnosis. MTX is now routinely used Financial fundings: None Conflict of interest : None Keywords: sarcoidosis, age, gender
PO3-21-12 SARCOID UVEITIS: A REVIEW OF 41 PATIENTS Couvidat Magalie, Mouriaux Frédéric (CHU CAEN )
Introduction: Sarcoidosis is a multisystem granulomatous disease which causes 3 to 8% of uveitis according to the litterature. The aim of this study was to describe the clinical aspects and the ocular involvement of sarcoid uveitis, and to d e t e rmine the best diagnostic pro c e d u re and tre at m e n t . Methods:All the patients with sarcoid uveitis in the departments of ophthalmology, pneumology, internal medicine and dermatology in Caen’ hospital during the 10 last years were reported Results: 13% of uveitis in our department were due to sar-
coidosis. In total, 41 patients were included. Anterior segment manifestations were involved in 83% of cases; posterior segment involvement occured in 63% of patients with cystoid macular edema in 14 cases. We found a mediastinal-lung involvement in 90% of cases. CT scan was a superior imaging modality compared to chest X-rays. The histopathological analysis was positive in 75% of cases; labial salivary gland biopsies were as reliable as bronchial biopsies, positive in 56% of cases. Bronchoalveolar lavage and gallium scintigraphy suggested the diagnosis of sar coidosis in the other cases. Corticosteroids were the mainstay of treatment but for 8 patients, the use of another systemic cytotoxic agent was required. The visual prognosis was good: final visual acuity (VA) was worse than 12/20 in one or both eyes in 11 cases; no patient had final VA lower than 6/20. Conclusions: sarcoidosis is a current etiology of uveitis; high frequency of sarcoidosis in our uveitis review is probably due
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Abstract Book to systematic research of this disease. Posterior segment manifestations are frequent. Diagnosis of sarcoidosis is difficult and requires biological, radiological procedure and biopsy. Oral corticotherapy and new cytotoxic drugs are efficient for treatment of sarcoid uveitis. Financial fundings: None Conflict of interest : None Keywords: uveitis- sarcoidosis- biopsy
PO3-21-13 CENTRAL RETINAL VASCULITIS ASSOCIATED WITH ASYMPTOMATIC GARDNERELLA VAGINALIS INFECTION Neri Piergiorgio (Polytechnic University of Marche-Ancona, Italy), Mariotti Cesare (Polytechnic University of MarcheAncona, Italy), Fortuna Cinzia (Polytechnic University of Marche-Ancona, Italy), G i ovannini A l fonso (Polytechnic University of Marche-Ancona, Italy) Introduction and objectives: To describe the occurrence of retinal vasculitis in 3 female patients with asymptomatic Gardnerella Vaginalis (GV) infection. Before being referred, patients had a course of systemic steroids with temporary beneficial effects. Relapses occurred each time they reduced the dose of steroids. Methods: The study design was: retrospective case series. Three female patients, who received the diagnosis of bilateral idiopathic central retinal vasculitis, were referred to the Eye Clinic of the “Ospedali Riuniti di Ancona”. Main outcome measures were: clinical features of central retinal vasculitis, results of tests performed and clinical outcome. Results: The patients were asymptomatic and denied history of systemic affections. All patients had angiographic findings of bilateral central retinal vasculitis; cystoid macular oedema was not detected both with fluorescein angiography (FA) and optical coherence tomography. Biomicroscopy revealed in all patients few cells in the vitreous; the binocular indirect ophthalmoscopy (BIO) score was 0+ in 3/3 cases. In case 1, best corrected visual acuity (BCVA) was 20/20 in both eyes; case 2 had 20/20 in the right eye and 20/25 in the left one, and case 3 had 20/20 in both eyes. All tests performed were negative, excepted for positive vaginal specimen for GV. The patients were then treated with oral ampicillin 2 g/day for 10 days. After the therapy, FA did not reveal signs of retinal vasculitis and vaginal specimens were negative for GV and other infections. BCVA remained stable. Conclusions: To our knowledge, no previous descriptions of retinal vasculitis associated with GV infection has been reported. GV infection could represent an immunologic trigger for retinal vasculitis, without severe sequela. The specif-
ic therapy was effective both for the retinal vasculitis and for the resolution of vaginal infection. Larger series should be evaluated to validate the data of this study. Financial fundings: None Conflict of interest : None Keywords: Gardnerella vaginalis, retinal vasculitis, ampicillin
PO3-21-14 AIDS ASSOCIATED LYMPHOMAS Ortega-Larrocea Gabriela (Instituto Ncional de Rehabilitacion & Hospital Medica Sur) Objectives: to describe clinical eye manifestations of AIDS patients with non-Hodgking´s lymphomas. Methods: 4 of 647 AIDS patients showed clinical eye manifestations related to systemic lymphomas. We described the 4 clinical cases. Results: optic neuritis, III nerve palsy and herpetic keratitis were the clinical associated ocular manifestations in AIDS patients with systemic or brain primary lymphomas. Conclusions: Non-Hodgkin´s lymphomas may increase in importance and we should be alert about ocular manifestations associated to the disease. Financial fundings: None Conflict of interest : None Keywords: AIDS, NON HODGKING´S LYMPHOMAS
PO3-21-15 ANTIPHOSPHOLIPID SYNDROME, DIAGNOSIS AND THREATMENT Jova n ovic Svetlana V (Medical Faculty Unive rsity of Kragujevac) Vukosavljevic S Miroslav (Military Medical Academy Belgrade), Jovanovic D Milenko (University of Kragujevac) Introduction and objectives: young patients with ocular manifestation as recurrent venous and arterial thrombosis, and thrombocytopenia. Methods and participiants: patients with recurrent venous and arterial thrombosis and elevated anticardiolipin antibody levels (aCL) and the presence of lupus anticoagulant antibody (LAC). Results: APS is considered if at least one of the clinical criteria is present: 1. vascular thrombosis confirmed by imaging or Doppler studies or histopathology without wall inflamma-
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Abstract Book tion, and one of the laboratory criteria: 1. titers of IgG or/and IgM isotype in blood aCL antibodies and 2. LAC present in plasma on two or more occasions at least 6 weeks apart. Conclusion: Diagnosis of APS is based on clinical characteristics and on the laboratory evidence of the aPL. The early recognition of patients with APS allows appropriate therapy to be instituted, reducing the risk of future thrombosis. Prognosis is related to the site of thrombosis and potential side effects of anticoagulant therapy. Financial fundings: None Conflict of interest : None Keywords: Vaso-occlusive retinopathy, anticardiolipin antibodies, lupus anticoagulant antibodies
PO3-21-16 ANTIMICROBIAL TREATMENT OF PRESUMED OCULAR TUBERCULOSIS. Bouillet Laurence (Internal medicine department, Grenoble u n ive rsity hospital), Kouprianoff Sabine (Dep a rtment of O p h t h a l m o l ogy, Grenoble university hospital), Romanet Jean-Paul (Department of Ophthalmology, Grenoble univer sity hospital), Chiquet Christophe (Department of Ophthalmology, Grenoble university hospital) Introduction: Uveitis secondary to a tuberculosis are rarely reported, even in a tertiary care center (1-5% of all uveitis). The prevalence of tuberculosis is low in Western Europe and the microbiological identification is often difficult. However, the anti tuberculosis treatment may be useful in some patients when the diagnosis of tuberculosis is presumed. Patients and methods: The clinical records of patients with suspected tuberculosis uveitis referred to the Ophthalmology Department of the Grenoble University, between January 2005 and January 2007 have been retrospectively analyzed. Patients were included in this series if they received a specific antituberculosis treatment. Results: this serie included 10 patients (3M / 7F, mean age 54.1 years). The clinical characteristics off ocular inflammation were: a bilateral panuveitis (6 patients), bilateral anterior uveitis (1), bilateral posterior uveitis (2), and unilateral pars planitis (1). The mean duration of uveitis before the p atient was re fe rred to us was 3 ye a rs (0.5-7 ye a rs). Tuberculin skin test, chest computerized tomography, BK sputums, and internal medicine consultation were performed for all patients. The diagnosis of presumed tuberculosis was based upon: history (5 cases), thorax scanner (6), tuberculin skin test (4 cases with a skin test > 14 mm). None had extraocular symptoms. Sputum cultures were negative; 2 adenopa-
thy biopsies were performed and the histological analysis confirmed the diagnosis. Nine patients received specific antituberculosis therapy, without systemic steroid therapy. All of them improved; no relapse occurred after 1 to 2 years after the end of therapy. In one case, tuberculosis specific therapy allowed to taper the systemic steroid therapy. Conclusion: the diagnosis of uveitis associated with tuberculosis is difficult since it depends on a spectrum of indirect signs. Bacteriological identification is rarely obtained. In presumed ocular tuberculosis, antituberculosis therapy may be useful to control intraocular inflammation, with or without steroid therapy. Financial fundings: None Conflict of interest : None Keywords: tuberculosis, uveitis, antibiotherapy
PO3-21-17 DIAGNOSIS AND MANAGEMENT OF OCULAR SARCOIDOSIS IN FRANCE Grenet Typhaine, Chapelon Christine, Bodaghi Bahram, Fardeau Christine, Piette Jean Charles, Lehoang Phuc (Pitie Salpetrière hospital) Purpose : To describe clinical features and paraclinical findings in patients managed for biopsy-proven ocular sarcoidosis at Pitié-Salpêtrière Hospital, Paris, France. Methods : Clinical presentation, angiographic features, laboratory investigations, treatment strategies and visual outcome of patients managed between 2000 and 2005 for biopsy-proven ocular sarcoidosis at Pitie-Salpetriere Hospital were retrospectively reviewed. Results : Among 3740 patients referred for the management of a first episode of uveitis, we identified 210 patients (5.6%) with presumed ocular sarcoidosis and 53 patients (20 M and 33 F) with biopsy-proven ocular sarcoidosis (1.4%). Mean age at diagnosis was 41.8 years (range 11-80 y). Most of patients were Caucasian (55%). Granulomatous panuveitis was present in 59% of cases followed by posterior uveitis (24%), anterior or intermediate uveitis (10%) and other forms of ocular inflammation in 7% of cases. Abnormal laboratory findings included : serum angiotensin converting enzyme (79.5%) and lysozyme (88.6%), chest CT-scan (83.3%), b ro n ch o a l veolar lavage (77.8%), gallium-scan (72%) and negative PPD (80%). Extraocular manifestations of sarcoidosis were diagnosed in 84.9% of patients, including pulmonary and neurological involvement in most of the cases. Histological confirmation was performed based on bronchoalveolar biopsy (40%); salivary gland biopsy (24%); cutaneous biopsy (9%) or other types (27%). Corticosteroids
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Abstract Book were used in 84.5% of cases and immunosuppressors were mandatory in 41% of cases. Methotrexate (40.9%) and azathioprine (22.7%) were the most commonly used drugs. Ocular complications occurred in 37.7% of cases, including macular edema (24.5%), choroidal neovascularisation (3.7%) and inflammatory retinal vein occlusion with secondary neovascular glaucoma (3.1%). Final visual acuity was improved or stabilized in most of patients (86%) with a mean followup of 36.3 months (range 7-211 months). Discussion : Biopsy-proven ocular sarcoidosis remains a rare cause of chronic uveitis in France. Corticosteroids remain the mainstay of treatment with a good visual outcome in most of cases. Despite the absence of histological evidences, the management of presumed ocular sarcoidosis is based on a similar strategy. Financial fundings: None Conflict of interest : None Keywords: sarcoidosis, granulomatous uveitis, corticoids
PO3-21-18 CHARACTERISTICS OF UVEITIS IN JUVENILE IDIOPATHIC ARTHRITIS (JIA) PATIENTS IN A SCREENING PROGRAM IN HONG KONG Lau Winnie WY (Department of Ophthalmology, Queen Mary Hospital, Hong Kong), Ng SY Anita (Department of Ophthalmology, Queen Mary Hospital, Hong Kong), Lee TL (Department of Pediatrics, Queen Mary Hospital, Hong Kong), Chan WN Clement (Department of Ophthalmology, Tung Wah Eastern, Hong Kong) Introduction and Objectives: To describe and investigate the characteristics of uveitis associated with juvenile associated arthritis (JIA) in a screening program in Hong Kong. Methods: We performed retrospective cohort study for 82 patients with an established diagnosis of JIA for uveitis. Results: Our cohort included 46 boys and 36 girls, and the majority (95.2%) were ethnic Chinese. The mean age of onset of arthritic symptoms was 9.7 years. The JIA subtypes of our patients were distributed as follows: oligoarthritis 32.9%, rheumatoid factor (RF) negative polyarthritis 30.5%, enthesitis related arthritis 20.7%, systemic JIA 6.1%, RF positive polyarthritis 4.9%, others 2.4% (no patients had psoriatic arthritis). 7 patients were positive for uveitis (1 bilateral case). All had anterior uveitis, and good visual acuity (>20/40). Only one child had experienced grittiness, and others were asympto-
matic. 4 patients had oligoarthritis, 2 had enthesitis related arthritis, and 1 had RF negative arthritis. No patients had any severe complications, e.g. cataract, synechiae, glaucoma or posterior segment complications. In our cohort, and increased duration between the time of the diagnosis of JIA and uveitis was associated with a slightly higher risk of developing uveitis (OR 1.02, C.I. 1.01-1.03). RF positivity is associated with a lower risk of uveitis (OR 0.90, C.I. 0.84-0.97). However, the associations between ANA positivity, gender, JIA subtype with presence of uveitis were not statistically significant. Conclusions: This study describes features of uveitis of JIA patients in a mainly ethnically Chinese group. The uveitis in our JIA patients were anterior, asymptomatic, with good visual acuity, and did not result in any major ocular complications. Our results may suggest ethnic differences in characteristics for uveitis in JIA patients in comparison with previous studies performed for Caucasian patients. Financial fundings: None Conflict of interest : None Keywords: uveitis, JIA, Hong Kong
PO3-21-19 OCULAR TUBERCULOSIS: SPECTRUM OF PRESENTATIONS, DIAGNOSIS AND MANAGEMENT IN AN ENDEMIC DEVELOPED COUNTRY Li Wei Heng (Tan Tock Seng Hospital, Singapore), Stephen Teoh (Tan Tock Seng Hospital, Singapore), Su Ling Ho (Tan Tock Seng Hospital, Singapore) Objective: To describe the spectrum of tuberculous ocular inflammation; its diagnosis and treatment and their dilemmas. Method: Retrospective case series. Patients: Thirty patients with tuberculous ocular inflammation between April 2000 to March 2007 from a single institution were included. Results: Of the 30 patients included, they were predominantly males (60%) and Chinese (56.7%). The age of presentation ranges from 26 to 72 years old, with a mean age of 45.7 years and median age of 46 years. 20 patients had unilateral involvement while 10 patients had bilateral involvement. The most common presentations were anterior uveitis (36.7%) and panuveitis (33.3%). Other presentations were: intermediate uveitis (5), posterior uveitis (1), scleritis (2) and Moorenâ&#x20AC;&#x2122;s ulcer (1). Diagnosis of tuberculosis ocular disease was made
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Abstract Book based on several methods in combination: 11 patients had a history of tuberculosis or previous exposure to tuberculosis, 6 out of 21 chest x-rays showed old pulmonary tuberculosis changes, and 17 out of 19 Mantoux tests were positive (>10x10mm induration). Howeve r, only 2 out of 9 aqueous/vitreous taps were PCR positive for Mycobacterium tuberculosis, and 2 out of 3 patients had serum TB T-spot test done which were positive. All 30 patients were treated with steroids: 29 patients with topical steroids, 10 required oral steroids, 9 required both topical and oral steroids, and 4 had intravenous pulse methylprednisolone. 2 patients required further immunosuppression with methotrexate and 3 with azathioprine. All patients were treated with anti-tuberculosis medications by the infectious disease physicians. One patient developed recalcitrant disease that marched on despite medication and received intravitreal amikacin. Conclusion: In this case series, the elusive diagnosis of ocular tuberculosis was clinched based on combination of medical history and positive investigation tests e.g. Mantoux, PCR. Along with systemic anti-tuberculosis antibiotics, steroids remain the mainstay of treatment with systemic immunosuppressants in selected cases. Financial fundings: Niz Conflict of interest : Nil Keywords: Tuberculosis, ocular, diagnosis
PO3-21-20 TWO CASES OF PAN-UVEITIS ASSOCIATED WITH TREAMENT OF HEPATITIS C USING INTERFERON Azumi Atsushi (Kobe University Gra d u ate School of Medicine, Department of Ophthalmology) Bessyo Hiroaki (Kobe University Graduate School of Medicine, Department of Ophthalmology ) , Fukuda Masahide (Kobe Unive rs i t y G ra d u ate School of Medicine, Department of Ophthalmology), Imai Hisanori (Kobe University Graduate School of Medicine, Department of Ophthalmology ) , Nakanishi Noriko (Kobe University Graduate School of Medicine, Department of Ophthalmology), Ishibashi Kazuki (Kobe University Graduate School of Medicine, Department of Ophthalmology) Introduction and Objects: Interferon (IFN) retinopathy is a well-known side effect of IFN therapy, which is also known for the ability to induce some kinds of autoimmune diseases. Herein reported are two cases of non- infectious pan-uveitis occurred during the therapy against hepatitis C. Methods; Observation of the intraocular conditions of two patients with hepatitis C treated with intravenous infusion of IFN. Case 1 was a 48-year-old man and case 2 was a 73-yearold man.
Results: Case 1 had anterior uveitis one month after initiation of IFN therapy. Sunset glow fundus developed in the next 5 months and lead the diagnosis of sympathetic ophthalmiae because he had glaucoma surgery. Case 2 developed granulomatous pan-uveitis in both eyes one year after initiation. Adding to the characteristic intraocular findings, negative result of tuberculin reaction, hypergammaglobulinemia, and abnormal accumulation in gallium scintigram strongly supported the diagnosis of sarcoidosis. Conclusions: It should be evaluated before IFN therapy whether the patient has a past history of uveitis. Occurrence of uveitis should be taken into consideration, when a patient has IFN therapy. Financial fundings: none Conflict of interest : non Keywords: Interferon therapy for hepatitis C, sarcoidosis, sympathetic ophthalmiae
PO3-21-21 OCULAR MANIFESTATIONS OF ACQUIRED IMMUNODEFICIENCY SYNDROME Sitompul Ratna (Department of Ophthalmology University of Indonesia Dr.Cipto Mangunkusumo Hospital Jakarta) Asyari Fatma (Department of Ophthalmology University of Indonesia Dr.Cipto Mangunkusumo Hospital Jakarta), Sjamsoe Soedarman (Department of Ophthalmology University of Indonesia Dr.Cipto Mangunkusumo Hospital Jakarta), Edwar Lukman (Department of Ophthalmology University of Indonesia Dr.Cipto Mangunkusumo Hospital Jakarta) Introduction & Objective: To describe the characteristic of patients with ocular manifestations of Acquired Immunodeficiency Syndrome (AIDS) in Infection and I m mu n o l ogy Division, D ep a rtement of Ophthalmology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital during 2005 â&#x20AC;&#x201C; 2007. Methods : A restropective review of ocular manifestation in AIDS patients. Data of sex, age, level of CD4+ T-cell count, mode of transmission, systemic manifestations, serology, ophthalmological status and systemic and ophthalmic therapy, were reviewed. Result : There were 40 HIV/AIDS patients, the most common risk factor for transmission was Injectien Drug User (IDU), ocular manifestation were mostly Cytomegalovirus (CMV) retinitis (71%), Human Immu n o d e fi c i e n cy Virus(HIV)-related retinopathy (7%) and Tuberculosis Choroiditis (3%). Vision acuity below 3/60 was 66% on admission . The l in 19 patiens. Twenty threeCD4+ T-cells count was below 50 cells/ patients (76%) were treated with Highly Active Anti-Retroviral Therapy (HAART) at the time
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Abstract Book of admission. All patients with CMV retinitis were treated with intravitreal Ganciclovir injection. Conclusion : Most of patiens with ocular manifestation of AIDS in the study were IDU as the main risk factor of transmission, and had CD4+ l. Mostly presented with CMV retinitis.T-cell count below 50 cells/ Most of the patients had been treated with HAART and CMV retinitis was treated with intravitreal Ganciclovir. Financial fundings: None Conflict of interest : None Keywords: HIV/AIDS, OCULAR, INFECTION, tuberculosis, outcomes, ocular inflammation
PO3-21-24 WHAT IS THE IMPORTANCE OF DEMODEX FOLLICULARUM IN BEHÇET’S DISEASE? Emre Sinan (Inonu University School of Medicine), Aycan M. Özlem (Inonu University School of Medicine), Atambay Metin (Inonu University School of Medicine), Bilak _emset tin (Inonu University School of Medicine), Daldal Nilgun (Inonu University School of Medicine), Karıncao_lu Yelda (Inonu University School of Medicine) INTRODUCTION AND OBJECTIVES: Demodex folliculorum (DF) is an obligate parasite of human pilosebeceous follicles, especially found in older people. It is mainly detected in hair follicles of the face and areas where sebum production is high. At the last years it is commonly detected at patients with immune system deprivation. In this study we aimed to document the DF prevalence among Behçet disease patients. METHODS: The patients who were referred and under control of ophthalmology clinic were included. 50 patients with Behçet’s disease and 107 patients with just refractive errors without any other ocular pathology and systemic disease were included. For parasite detection, 3 eyelashes from each inferior eyelid were epilated. We also performed standardized skin surface biopsy (SSSB) for detection of parasite at cheeks of patients. Epilated eyelashes and cheek samples were prepared with Hoyer’s solution for investigation under light microscope with x100 magnification . RESULTS: Among Behçet Disease group there were 22 female and 28 male patients. Control group composed of 50 female and 57 male patients. Mean age were 37,96 and 38.29 for Behçet’s patients and control group, respectively. DF prevalence at eyelashes was 64 % (32/50) for Behçet’s disease patients and 12 % (13/107) for control group. SSSB of cheek revealed 12 % (6/50) positivity for Behçet’s disease and none of control group patients. Statistical analysis docu-
mented meaningful diffe rence between study groups (p<0.05). CONCLUSION: Increase of DF prevalence at immune system dysfunction is a well known subject. Investigation of DF in Behçet’s disease may be very useful even in patients without any complaint for treatment of ocular and eyelid dyscomfort of these patients. Financial fundings: None Conflict of interest: None Keywords: Demodex follicularum, Behçet’s disease
PO3-21-25 BILATERAL TROPHERYMA WHIPPELII PANUVEITIS Lefèbv re Pierre R B (Erasme University Hospital, O p h t h a l m o l ogy, Brussels), Nubourgh Isabelle (Era s m e U n ive rsity Hospital, I n t e rnal Medicine, Brussels), L e my Anne (Erasme University Hospital, Internal Medicine, Brussels), Dumarey Nicolas (Erasme University Hospital, N u clear Medicine, B ru s s e l s ) , Vandergheynst Frédéric (Erasme University Hospital, Internal Medicine, Brussels), Decaux Guy (Erasme Unive rsity Hospital, Internal Medicine, Brussels) Introduction and objectives: to report the usefulness of the anterior chamber tap in the diagnosis of ocular Whipple disease. Methods: case report. Results: a 57 year old caucasian man presented with a few weeks history of decreased visual acuity in both eyes (20/200 RE - 20/60 LE), and a fever of unknown origin. Two years previously a Behçet disease had been diagnosed and 2 immunosuppressive agents had been started. Ophthalmic examination disclosed a bilateral granulomatous panuveitis with posterior synechiae, vitritis, papillitis, macular edema, and retinal hemorrhages. PCR analysis on aqueous humor is positive for Tropheryma whippelii. A treatment with intravenous ceftriaxone is initialized and followed by oral sulfamethoxazole and trimethoprime. Visual acuity gradually improves to 20/20 both eyes. Conclusion: anterior chamber tap can be useful in the diagnosis of ocular Whipple disease. Financial fundings: / Conflict of interest: / Keywords: Whipple disease, Behçet disease, anterior chamber tap
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Abstract Book PO3-21-26 A RARE CASE OF CANCER ASSOCIATED CONE DYSFUNCTION Massaoutis Panos (Moorfields Eye Hospital), Vugler Anthony (Institute of Ophthalmology ) , Holder Gra h a m (Moorfields Eye Hospital), Pavesio Carlos (Moorfields Eye Hospital), Tufail Adnan (Moorfields Eye Hospital) Introduction: Paraneoplastic cone dysfunction is a subset of cancer associated retinopathy (CAR) which is not fully understood. There are only 3 cases reported one of which describes antibody activity with retinal antigen approximating 40Kd in the outer segment of the photoreceptor layer. We present a case with progressive cone dysfunction associated with recurrent transitional cell bladder carcinoma expressing recoverin, M/L opsin and cone-transducin. Methods: Retrospective case study of a 65 year old Asian m a l e, with diabetic maculopat hy and transitional cell bladder carcinoma with progressive bilat e ral loss of vision. Clinical c o u rs e, histopat h o l ogy, electrodiagnostic rep o rts, and immu n ohistopathology of the tumour tissue are being discussed. Results: Our patient experienced progressive visual loss with photophobia entopic phenomena and loss of colour vision. This was initially thought to be secondary to his significant diabetic maculopathy and the subsequent macular laser treatment. However further clinical investigation including electrodiagnostics revealed loss of cone function which could not be attributed to his macular grid laser treatment alone. Immunohistochemistry of the tumour tissue showed expression of recoverin, cone-transducin and M/L opsin. Conclusions: This case illustrates that high index of suspicion for CAR is required especially when coexisting pathology cannot fully explain the patient’s symptoms. The patient’s diabetic eye disease may have predisposed him to development of CAR by breakdown of the blood-retina barrier. Electrodiagnostic tests are invaluable in the diagnosis and immunohistochemistry of the tumour tissue is useful in confirming the diagnosis and expanding our understanding of the condition. Financial fundings: None Conflict of interest : None Keywords: CAR, cone dysfunction
PO3-21-27 CHALLENGING PRESENTATIONS OF UVEITIS IN PATIENTS WITH COMMON VARIABLE IMMUNODEFICIENCY. Schmit Isabelle (Hôpital La Pitié Salpêtrière, Université Laval), Ducos Ghylaine (Hôpital La Pitié Salpêtrière), Mura Frédéric (CHU Montpellier), Terrada Céline (Hôpital La Pitié Salpêtrière), Le Hoang Phuc (Hôpital La Pitié Salpêtrière), Bodaghi Bahram (Hôpital La Pitié Salpêtrière)
Common variable immunodeficiency (CVID) is an immunol ogical disorder chara c t e ri zed by low - l evel serum immunoglobulins and impaired antibody production by B lymphocytes or plasma cells. Patients with CVID present with recurrent infections and have a higher risk of developing autoimmune diseases and certain malignancies. Rare cases of uveitis have been described in association with CVID. We report three cases seen at La Pitie Salpetriere Hospital in Paris. A 50-year-old woman presented with an exudative retinal detachment in her right eye (RE) and uveitis in her left eye (LE). She had had recurrent infections and multiple autoimmune diseases in the past years and had been treated with intravenous immunoglobulin (IVIG) for CVID for the last two years. She refused any additional biopsies therefore a definite diagnosis was not possible but the clinical presentation was compatible with granulomatous choroiditis. The RE exudative retinal detachment resorbed and the LE uveitis was stabilized under immunosuppressive therapy but the visual prognosis in the RE remains poor. A 34-year-old man presented with panuveitis in his LE. He had contracted a variety of infections since the age of twelve and had been diagnosed recently with sarcoidosis and CVID for which IVIG treatment was instituted. He had vitritis in both eyes with many chorioretinal scars bilaterally and papillitis in his RE that disappeared gradually under IVIG and systemic corticosteroids. A 25-year-old woman presented with uveitis in her LE that didn’t improve under systemic corticosteroids. She was diagnosed with CVID based on immunoglobulin electrophoresis and lymphocytes phenotyping during investigation. She was subsequently placed under IVIG with barely any improvement of her LE visual acuity which remained suboptimal. CVID is a potentially severe medical condition associated with a variety of ocular presentations. Therapeutic options should be adapted to the type and severity of uveitis. Financial fundings: None Conflict of interest: None Keywords: uveitis, common variable immunodeficiency
PO3-24-01 COMPARISON OF TWO LOW DOSE REGIMES OF CYCLOSPORINE-A IN THE TREATMENT OF ENDOGENOUS UVEITIS Subhash Dadeya Chand (guru nanak eye center), Kamlesh (guru nanak eye center) Aim: To describe our experience of low dose cyclosporine-A (CsA) and to compare the efficacy of 5mg and 2.5 mg/kg b o dy weight/day of CsA in tre atment of uveitis.
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Abstract Book Material and Methods: Fourteen patients of endogenous uveitis who failed to respond to systemic steroids were randomly divided into two groups. Group I and II received CsA in the dose of 5mg and 2.5-mg/kg-body weight/day respectively. Results: The post treatment best-corrected visual acuity ranged from 6/60 to 6/9 in Group I and hand movements close to face to 6/12 in Group II after a mean follow- up of eight months. 58% patients were treated successfully. The side effects like anemia, gingival hyperplasia and nephrotoxicity were seen in Group I patients. Conclusions: CsA in the dose of 2.5-mg/kg body weight/day can be recommended safely for treating the patients of endogenous uveitis. Financial fundings: none Conflict of interest: none Keywords: cyclosporine,uveitis ,low dose.
PO3-24-02 QUALITY OF LIFE IN PATIENTS WITH UVEITIS ON CHRONIC IMMUNOSUPPRESSIVE TREATMENT M o d o rati Giulio (Dept. Ophthalmology, San Raffa e l e Hospital, Milan, Italy), Miserocchi Elisabetta (Dept. Ophthalmology, San Raffaele Hospital, Milan, Italy), Colucci Annalisa (Dept. Ophthalmology, San Raffa e l e Hospital, Milan, Italy), Rama Paolo (Dept. Ophthalmology, San Raffaele Hospital, Milan, Italy), Mosconi Paola (Dept. Oncology, Istituto Mario Negri, Milan, Italy) Introduction and objectives: to assess health-related quality of life in patients with uveitis on chronic systemic immunosuppressants. Methods: consecutive patients with chronic non infectious uveitis on systemic immunosuppressive treatment seen at the Ocular Immu n o l ogy and Uveitis Serv i c e, San Raffaele Hospital, Milan, were enrolled. Health status was evaluated with the Italian version of SF-36 questionnaire in 8 dimensions: physical functioning and disability, body pain, general health, vitality, social functioning, emotional disability, mental health. Demographic characteristics, educational and employment informations were collected. Results: 100 caucasian patients (37 male, 63 female) with a median age of 46,31 years (range 10-76) were analyzed. The uveitis was bilateral in 88% of patients. Location of uveitis was: anterior (9%), intermediate (12%), posterior (48%) and panuveitis (31%). The most frequent diagnosis encountered were:idiopathic (32%), sarcoidosis (15%) and Behcet disease (15%). The SF-36 physical and mental component summary scores were lower among patients with uveitis than in gener-
al Italian population (p<0.01); the most significant differences were found with respect to age at onset of uveitis, duration of disease and visual acuity less than 5.10. No differences were found with respect to body pain. Conclusions: Patients with uveitis on ch ronic systemic immunosuppressants rep o rted marke d ly poorer general health status than normal subjects. Financial fundings: none Conflict of interest: none Keywords: Quality of Life, Uveitis, Immunosuppressive treatment
PO3-24-03 CONVERSION FROM MYCOPHENOLATE MOFETIL TO ENTERIC-COATED MYCOPHENOLATE SODIUM IN OCULAR INFLAMMATION Pleyer Uwe Schmidt Nadine, Feist Oliver, Torun Necip (Department of Ophthalmology, CharitĂŠ â&#x20AC;&#x201C; University Medicine Berlin, Germany), I n t roduction and objective s : Mycophenolate mofetil (MMF) has gained acceptance as an immune modulatory agent in the trea tment of autoimmune disorders such as uveitis. It represented a major advance, although optimal use may be limited in particular by gastrointestinal (GI) sideeffects in up to 50% patients. This prospective study was undert a ken to eva l u ate the effect of conve rsion from my c o p h e n o l ate mofetil (MMF) to an enteric-coated mycophenolate sodium (EC-MPS). Patients and methods: Within a cohort of > 200 patients treated with MMF we prospectively followed 18 inidviduals that developed gastrointestinal side effects. Because of limited treatment alternatives, conversion to an enteric-coated mycophenolate sodium (EC-MPS) was undertaken. A stand a rdised questionnaire (GSRS) was completed by each patient regarding GI disorders, at predefined intervals during the study. Based on an analog scale resolution of symptoms was defined when 80% reduction occurred, and improvement when a 50% reduction could be achived. Results: The spectrum of underlying disor ders included uveitis (n=15) and ocular cicatricial pemphigoid (n=3) that were initially treated with MMF (1000 mg BID). All patients could be kept on ECMPS treatment and followed with a mean follow up of 44 weeks (+/- 12). The maximum of scores on GSRS was reached at baseline (conversion to ECMPS) in all but 3 patients. However, GSRS scores improved significantly between baseline and Visit 4 (3 months) and remained stable further on (P<0.03). In all but one (uveitis) patient the underlying disorders was under control demonstrating similar efficacy of MMF and EC-MPS teatment.
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Abstract Book Conclusion: The use of EC-MPS appears as a valid treatment option in ocular autoimmune disorders. In particular patients with gastrointestinal problems may profit from a significantly reduced potential of undesired effects. Financial fundings: Charite grant Conflict of interest: NONE Keywords: uveitis, treatment, side effects
can be controlled if adequate dosage is maintained. Despite lack of evidence of direct association of lymphoma with use of infliximab, careful monitoring is needed in these patients. This small series indicates that these drugs may not be as effective in non-uveitic ocular inflammation. Financial fundings: None Conflict of interest: None Keywords: chronic uveitis, TNF alpha inhibitors, ocular inflammation
PO3-24-04 ADALIMUMAB AND INFLIXIMAB IN THE TREATMENT OF NON-INFECTIOUS OCULAR INFLAMMATION Gullapalli Vamsi K (UMDNJ-New Jersey Medical School), Chu S David (UMDNJ-New Je rs ey Medical School) Purpose: To study the efficacy of tumor necrosis factor alpha-inhibitors, adalimumab and infliximab, in the treatment of non-infectious ocular inflammation. Methods: A retrospective study of patients with ocular inflammation who were treated with infliximab or adalimumab. Patients had been previously treated unsuccessfully with immunomodulatory drugs. Improvement of inflammation, recurrences, and adverse effects were the main outcomes monitored. Results: Charts of 23 patients, (uveitis: 19; scleritis:1; episcleritis:1, i d i o p athic retinal vasculitis:1) we re rev i ewed. Mean age age was 30.5 ± 23.4 yrs. Associated conditions i n cluded juvenile idiopathic art h ritis (n=8), rheumatoid arthritis (n=3), sarcoid (n=3), HLA-B27 (n=2), pemphigoid, b i rdshot ch o ri o re t i n o p athy, C oga n ’s syndro m e, psoriasis, Sjogren’s, and Crohn’s (n=1 each). Patients on adalimumab (n=14) were followed over a period of 6 to 36 months (mean 12.8 ± 8 months) Inflammation resolved in 14 out of 14 patients after starting adalimumab. 9 patients with uveitis have not had a recurrence; 3 patients had one episode of recurrence each. One required restarting predinosone/methotrex ate; one required increased adalimumab frequency; and one had poor compliance. Both nonuveitic patients had one episode of recurrence each. One patient complained of severe pain at injection site. Patients on infliximab (n=9) were followed for 15 to 48 months (mean 33.8 ± 10.1 months). Improved activity was noted in 8 of 8 patients. 2 patients had one episode of recurrence each. One patient developed non-Hodgkin’s lymphoma and infliximab was discontinued. Conclusions: Short term results of adalimumab and infliximab treatment show that non-infectious ocular inflammation
PO3-24-05 ANTI-TNF THERAPIES IN THE MANAGEMENT OF AUTOIMMUNE CHRONIC UVEITIS Ortega-Larrocea Gabriela (Instituto Nacional de Rehabilitacion & Hospital Medica Sur) Objectives: to study the effectiveness of etanercept, infliximab and adalimumab in the treatment of chronic autoimmune uveitis. Methods: a case series of 8 patients with anti-TNF theraphy for chronic non-infectious uveitis. Tuberculosis infection and Multiple sclerosis were rule out. Results: resolution of inflammation was observed in all cases at 3 weeks (6 to 31 days), in 5 patients steroid were discontinued, the principal side effects were itching at injection site (adalimumab). The fellow-up was 16 months (3 to 50 months). Conclusions: anti-TNF are effective in the treatment of chronic autoimmune uveitis. Objectives: to study the effectiveness of etanercept, infliximab and adalimumab in the treatment of chronic autoimmune uveitis. Financial fundings: none Conflict of interest: none Key words: Anti-TNF, autoimmune uveitis, b i o l ogical therapy
PO3-24-06 COMPARISON BETWEEN DACLIZUMAB AND INFLIXIMAB IN THE TREATMENT OF NONINFECTIOUS UVEITIS. Diaz-Llopis Manuel (Hospital General Unive rs i t a rio de Valencia), Salom David (Hospital General Universitario de Valencia), Cervera Enrique (Hospital General Universitario de Valencia), Udaondo Patricia (Hospital Genera l
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Abstract Book Unive rs i t a rio de Valencia), Garc i a - D e l p e ch Salvador (Hospital General Universitario de Valencia), Amselem Luis (Hospital General Universitario de Valencia) Introduction and Objectives: To compare the safety and effcacy of Daclizumab and Infliximab for the treatment of uncontrolled noninfectious intermediate uveitis, posterior uveitis and panuveítis. Methods: Prospective nonrandomized interventional trial over 20 patients with noninfectious intermediate uveitis, posterior uveitis and panuveítis with a history of at least one relapse in their ocular inflammation during 6 months prior to the beginning of the study in spite of treatment with systemic corticosteroids and 1 or more immunosuppressive drugs. 10 patients were treated with Daclizumab (1mg/kg) every 4 weeks and 10 more patients were treated with Infliximab (5mg/kg) every 8 weeks. The groups were equally distributed regarding the type of the uveitis and the systemic immunosuppression medication load. The main outcome measures were the Early Treatment of Diabetic Study (EDTRS) visual acuity, the systemic immunosuppression medication load and the ocular inflammation using standardized grading scales. Patients were examined every 3 months for a follow-up time of 12 moths. Results: 7 of 10 patients (70%) in the Daclizumab treatment group didn’t show any relapse of their ocular inflammation, 6 patients of the Daclizumab treatment group reduced their systemic corticosteroid dose until 5 mg/day. 10 of 10 patients (100%) in the Infliximab treatment group didn’t show any re l apse of their ocular infl a m m ation. 8 patients of the Infliximab treatment group reduced their systemic corticosteroid dose until 5 mg/day. No side effects were observed during the follow-up in any of the groups, but Infliximab s h owed some minor reactions, l i ke hypotension and headach e, d u ring the administration of the medicat i o n . Conclusions: Infliximab had a higher rate of success in controlling the ocular inflammation in these patients and it was clearly more effective in patients with Behçet disease. No serious side effects were observed with Daclizumab and Infliximab but caution is needed during the administration of Infliximab. Financial fundings: None Conflict of interest: The authors have no financial interest in this study Keywords: Daclizumab, Infliximab, Noninfectious Uveitis
PO3-24-07 EVALUATION OF SAFETY AND EFFICACY OF ADALIMUMAB IN THE TREATMENT OF NONINFECTIOUS UVEITIS. Diaz-Llopis Manuel (Hospital General Unive rs i t a rio de Valencia, Spain), Salom David (Hospital Genera l Universitario de Valencia, Spain), Amselem Luis (Hospital General Universitario de Valencia, Spain), Udaondo Patricia (Hospital General Universitario de Valencia, Spain), GarciaD e l p e ch Salvador (Hospital General Univers i t a rio de Valencia, Spain), H e rn a n d e z - G a r fella Marisa (Hospital General Universitario de Valencia, Spain) I n t roduction and Objectives: Adalimu m ab is a 100% humanized monoclonal antibody with an anti Tumor Necrosis Factor (TNF) activity with the advantage of the subcutaneous administration. The purpose of this study is to evaluate the efficacy and safety of subcutaneous adalimumab for therapy-resistant uveitis. Methods: Nineteen consecutive patients with bilateral, sightthreatening, non-infectious uveitis with chronic dependence on immunosuppressive drugs were treated with adalimumab 40 mg every other week for one year. Main outcome measures: 1) Best-corrected visual acuity; 2) Degree of ocular i n fl a m m ation ;3) Ability to reduce immu n o s u p p re s s ive drugs; 4) Lack of clinical re c u rrences; 5) Macular edema(OCT). Clinical success was judged by the composite clinical end point of the five different outcome measures. Results: All patients demonstrated a rapid and go o d response. Nineteen patients (100%) met criteria for clinical success at the one year follow-up. Visual acuity: 30 of 38 eyes (78.94%) improved, 6 eyes (15.78%) presented no change and 2 eyes (5.26%) had continued visual loss. A n t e rior segment: 21 eyes (55.26%) presented reduced inflammation and 17 eyes (44.73%) had no change. Posterior segment: 29 eyes (76.31%) had demonstrated rapid response and achieved disease improvement, 9 eyes (23.68%) presented no change, and no eyes worsened. Concomitant immunosuppressive drugs were reduced by at least 50% in 19 p atients (100%) and there we re no seve re recurrences. Macular thickness was significantly reduced from 390.63 ± 138.18 μ to 241.05 ± 64.63 μ (p < 0.05) at the end of followup. No adverse effects were observed. Conclusions: Adalimumab seems to be an effective and safe therapy for the management of re f ra c t o ry uveitis, and appears to reduce the need for concomitant immunosuppressive treatment. Financial fundings: None Conflict of interest : The authors have no financial interest in this study Keywords: Adalimumab, Noninfectious uveitis, Treatment
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Abstract Book PO3-24-08 LIMITED VALUE OF CYCLOSPORINE A FOR THE TREATMENT OF UVEITIS ASSOCIATED WITH JUVENILE IDIOPATHIC ARTHRITIS Heiligenhaus Arnd1, Tappeiner Christoph1, Heinz Carsten1, Michels Hartmut2, Ganser Gerd3 1 Department of Ophthalmology, Uveitis Center, at St. Franziskus Hospital Muenster, Germany 2 German Center of Pediatric Rheumatology, GarmischPartenkirchen, Germany 3 Department of Pediatric Rheumatology, St. Josef Stift, Sendenhorst, Germany Objectives: Juvenile idiopathic arthritis (JIA) is often associated with seve re ch ronic anterior uveitis (CAU) and immunosuppressive therapy may be required. In this study, the value of cyclosporine A (CsA) as monotherapy or as combination therapy for treating uveitis was studied in a large cohort of JIA children. Methods: Multicentre, retrospective study including 82 JIA children (girls n=60) suffering from unilateral or bilateral (n=55) CAU. JIA subgroups included oligoarthritis (n=65), RF-negative polyarthritis (n=13), psoriatic arthritis (n=1) or other arthritis (n=3). In all patients, the indication for CsA was active uveitis although they were on topical or systemic corticosteroids, MTX or other immunosuppressive drugs. Results: With CsA (mean dosage 2.9 mg/kg), systemic immunosuppressive drugs and steroids could be reduced by 50% (n=22) and tapered off (n=23) or topical steroids reduced to 2 drops/eye/day (n=18) in selected patients (mean follow-up 3.9 years). Uveitis was quiescent in 6 of 25 (24%) patients with CsA as systemic monotherapy and in another 35 of 72 patients (48.6%) when combined with the immunosuppressives already being given. When CsA was added to MTX (n=37), uveitis quiescence was achieved in 48.6%, and the response in terms of sparing of immunosuppressives and steroids was good or moderate in 8 patients each, but poor in another 18. Pre-existing cystoid macular edema did not resolve under CsA treatment in any of the patients. In 9 patients (11%), CsA was discontinued because of systemic hypertension (n=1), elevated creatinine levels (n=3) or other adverse effects (n=5). Conclusions: These observations suggest that CsA has limited Financial fundings: None Conflict of interest: None Keywords: juvenile idiopathic arthritis, cyclosporine A, treatment
PO3-24-09 PARS PLANA VITRECTOMY VERSUS IMMUNOMODULATORY THERAPY FOR INTERMEDIATE UVEITIS: A PROSPECTIVE, RANDOMIZED PILOT STUDY Quinones Karina (Massachusetts Eye Research and Surgery Institute), Yilmaz Taygan (Massachusetts Eye Research and Surgery Institute), Choi John (Massachusetts Eye Research and Surgery Institute), Foster C. Stephen (Massachusetts Eye Research and Surgery Institute) Purpose: To determine whether pars plana vitrectomy (PPV) is superior to immunomodulatory therapy (IMT) for patients with intermediate uveitis (IU). Methods: Patients with recalcitrant IU associated with degradation of visual acuity (VA) despite standard treatment were randomized prospectively to receive either PPV or IMT. Vitrectomies were performed by the same surgeon (CSF). IMT was initiated with methotrexate (MTX). Outcomes measures, including best-corrected VA, intraocular pressure (IOP), and anterior chamber and vitreous cellular infiltrate, were collected pre- and postoperatively at 6-month intervals for up to 18 months. Results: Sixteen patients (20 eyes) were randomized to the PPV (9 patients, 11 eyes) or the IMT group (7 patients, 9 eyes). Patients included 12 females and 4 males aged 7 to 77 years (mean 33 yrs). There were no intraoperative complications associated with PPV. Greater than expected self-limited leukopenia and anemia in one patient each were the only IMT complications. Nine of 11 eyes (82%) treated with PPV showed resolution of inflammation by the end of follow-up. Six of 9 eyes (67%) given IMT had persistent inflammation and required subsequent PPV. PPV patients showed greater improvement in Snellen line, IOP and vitreous cell reduction, although no data point was statistically significant at p=0.05. Four (36%) PPV and 4 (44%) IMT patients had cataract progression. Three PPV patients had cystoid macular edema (CME) at presentation; all resolved postoperatively. CME improved in 2 of 3 patients in the IMT group. Conclusions: A higher percentage of patients treated with PPV had improvement or resolution of uveitis compared to those given IMT with over half of IMT eyes eventually requiring PPV. Further evaluation in a multicenter, randomized, controlled clinical trial with longer follow-up is needed to confirm these results and reach statistically valid conclusions. Financial fundings: None Conflict of interest: No potential conflicts Keywords: intermediate uveitis, vitrectomy, immunosuppresion
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Abstract Book PO3-24-11 SYSTEMIC CORTICOTHERAPY INITIATED BY BOLUS IN NON INFECTIOUS POSTERIOR UVEITIS MARECHAL Cécile (CHU Angers), LAMIREL Cédric (CHU Angers), BUISSON Elisabeth (CHU Angers), MAZIT Cheriff (CHU A n ge rs), EBRAN Jean Marc (CHU A n ge rs), COCHEREAU Isabelle (CHU Angers) Objectives: To evaluate effectiveness and tolerance of long course systemic corticotherapy initiated by IV bolus in non infectious posterior uveitis. Methods: Retrospective study from 2001 to 2006. The corticotherapy was started by IV bolus of methylprednisolone over 3 days, and followed by 1 mg/kg/d oral prednisone. Then the posology was decreased according to the clinical evolution. Results: 44 patients (32 women,12 men) with an average age of 46 were included. The average follow up was 21 months. The etiology of uveitis was known in 41% of the cases. Uveitis was bilateral in 60 % of the cases (70 eyes). For the worse eye, the average initial vision was 3,0, the final vision was 6,8. Among the 24 eyes having an initial macular thickness higher than 250μm, the average macular thickness decreased from 393μm to 264μm. Side effects were noted only during oral corticotherapy. No incident occured during the bolus. Oral corticotherapy was maintened with more than 20 mg for 3,9 months, between 20 and 10 mg for 3,4 months, and between 10 and 0 mg for 6,6 months.Among 24 patients having stopped the systemic corticotherapy, 20 did it without an ACTH test. Seven patients were corticodependant to an average of 9 mg/day. Discussion: Corticotherapy initiated by bolus is r apidly effective on the intra-ocular inflammation, then on the macular oedema. Its side effects appear during the oral corticotherapy, whereas bolus are well tolerated. The visual acuity depends primarily on the macular state. Conclusion: The switch to systemic treatment marks a turning point in the evolution of uveitis. Corticotherapy remains the first line treatment on emergency for its prompt efficacy. Its side effects are known and easily managed. The benefit/risk ratio of the bolus appears to be favorable.
PO3-24-12 EFFICACY AND SAFETY RESULTS FROM THE REMICADE EUROPEAN STUDY FOR CHRONIC UVEITIS (RESCU) Presenter: Marc D. de Smet for the RESCU participants Purpose: Infliximab is a monoclonal IgG1 chimeric monoclonal antibody, active against soluble and membrane bound TNF-a. The objectives of this prospective non randomized study were: (1) determine the response to infliximab in patients with intermediate and/or posterior uveitis intolerant or unresponsive to standard therapy; (2) determine the incidence of side effects; (3) to determine in long term remission is possible after 46 weeks of treatment. The current report will address the first two objectives. Methods: Uveitis patients from 10 European centers were recruited to receive infliximab 5 mg/kg at weeks 0, 2, 6, and every 8 weeks through week 46. Starting at week 6, and over a 6 week period a taper of concomittant medications was initiated when in the view of the treating physician such a taper was warranted. Patients were allowed to remain on low dose prednisone (7.5 mg/day), methotrexate (7.5 mg/week) or azathioprine. Patients were withdrawn from the study if their vision dropped 2+ ETDRS lines, gained 2 vitreous haze scores, developed a retinal infarction, or they were restarted on immunosuppressive therapy. Results: 49 patients were included in the study, 6 were withdrawn (W), while 7 reached an end point (EP). The diagnostic groups included: Behçet’s disease (n=9, EP=1), sarcoidosis (n=5, W=1), intermediate uveitis (n=11, W=1, EP=1), birdshot retinochoroiditis (n=10, W=1, EP=4), idiopathic vasculitis (n=7, W=1, EP=1), and sympathetic ophthalmia/Vogt Koya n agi Harada (n=7, W=3, EP=1). Withdrawals were for: tuberculosis (1), major inclusion violations (2), allergy (1), drug reaction (2). The mean improvement in ETDRS letters of visual acuity was OD 9 (SD 14, p<0.001), OS 7 (SD 9, p<0.001). Taking all eyes, 50% achieved a 10 letter improvement by week 22. Vitreous haze decreased in 68% of patients. Medication taper according to the protocol guideline was achieved in 8 patients. A taper was achieved in all patients. Conclusion: The 46-week data suggests that infliximab is effective in uveitis originating from a broad range of diseases. It is well tolerated.
Financial fundings: None Conflict of interest: None Keywords: CORTICOTHERAPY POSTERIOR UVEITIS
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Abstract Book PO3-26-01 OCULAR MANIFESTATIONS IN HIV INFECTIONS IN INDIA IN THE ERA OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: A PERIOD OF TRANSITION Gharai Sujit (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences), Garg Satpal (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences), Venkatesh P ra d e ep (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences), Vohra Rajpal (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences), Sharma K S (Department of Medicine, All India Institute of Medical Sciences) Introduction & Objectives: To evaluate ophthalmic manifestations in patients with HIV infection in the era of HAART at the ap ex institute for healthcare in India. Methods: A complete ophthalmological examination was performed on each patient between September 2004 and September 2006. Results: 135 consecutive HIV infected patients were examined for ocular manifestations. Of these 20% had category A HIV infection, 23.7% had category B HIV infection, 56.3% had category C HIV infection. 74% were male and 26% were female. The median age of patients was 34 yr. 62.2% patients were on HAART. 44% patients had ophthalmic manifestation, the most common being cy t o m ega l ov i rus retinitis (18.5%). Retinal detachment was seen in 68% of CMV retinitis patients. HIV vasculopathy was seen in 9.6% of patients. Other lesions included immune recove ry uveitis(~3.7%), acute retinal necrosis(~3.7%), tubercular choroiditis (~3.7%), cryptococcal choroiditis(~0.7%), neuroophthalmic manifestations(~11.1%) and anterior segment m a n i fe s t ations(~11.1%). 9% patients had ocular lesions without any ophthalmic symptom. Amongst those who had ophthalmic involvement, 44.4% had CD4 count <100 cells/l and 70.3% had CD4 count <200 cells/l. Conclusions: There seems to be an increased risk of developing ocular opportunistic infections like CMV retinitis and its complications, neuro-ophthalmological complications and anterior segment complications, with the introduction of providing low cost or free HAART in India, due to increase in life expectancy and immune recovery, which are potentially blinding and for which the treatment is very expensive. Hence an urgent need to develop affordable treatments for vision threatening ophthalmic manifestations of HIV exists.
PO3-26-02 CLINICAL EVIDENCES AND EVOLUTION OF TUBERCULOSIS UVEITIS Tognon Sofia (Ophthalmology Unit - Padua University Italy), Menolascina Luisa (Ophthalmology Unit - Padua University - Italy), Motterle Laura (Ophthalmology Unit Padua University - Italy) Introduction and Objectives: The recent increase of systemic Tuberculosis (TB) morbidity in Italy is concomitant with a parallel increase of ocular TB. We tried to analyze the clinical characteristics and evolution of tubercular uveitis in relation with pharmacological treatment. Patients and Methods: We considered 290 consecutive patients with posterior/pan-uveitis referred to our tertiary care institution in the last two years. After a complete screening for infectious and immunological diseases, we detected a tubercular origin of uveitis in 36 patients (12.7%). Clinical Results: In our recent experience, the incidence of tubercular uveitis has increased by 5% compared to 10 years ago. There was a strong tropism of the Mycobacterium Tuberculosis for the choroid, along a with a retinal and vitreal involvement by the accompanying immune reaction to the eye infection. In our experience, tubercular choroiditis has atypical features in about 30% of patients, with serpiginous or multifocal-like aspects. The response to multi-drug regimens, carried out over 1 year according to WHO guidelines, was effective only when the onset of systemic infection and choroiditis was recent (less then 1 year), while it was disappointing in older ocular disease, with a longer and persistent ocular immune inflammation. Conclusions: In our recent clinical experience, the tubercular uveitis showed a significant increase. The possible occurrence of atypical tubercular choroiditis leads to reconsider the pat h ogenesis of serp i ginous and mu l t i focal forms. Precocious diagnosis and prompt treatment are of key importance to improve the prognosis and to avoid the persistence of chronic immunological eye inflammation. Financial fundings: None Conflict of interest: None Keywords: TUBERCULOSIS UVEITIS, ASPECTS, EVOLUTION
Financial fundings: nil Conflict of interest: none Keywords: Ocular, HIV, AIDS
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 182
Abstract Book PO3-26-03 COMPARISON OF PATIENTS WITH OCULAR TUBERCULOSIS IN THE 1990S AND 2000S Suzuki Jun (Tokyo medical university hospital), Oh-i Keiko (Tokyo medical university hospital), Kezuka Takeshi (Tokyo medical university hospital), Sakai Jun-ichi (Tokyo medical university hospital), Goto Hiroshi (Tokyo medical university hospital) Introduction and objectives: To compare clinical findings in patients with ocular tuberculosis seen in two different decades (1990s and 2000s) to determine if there has been a shift toward less severe disease. Methods: 34 patients with ocular tuberculosis who were seen at the uveitis clinic of Tokyo Medical University Hospital between January 1990 and February 2007 were enrolled. Patients were divided into two groups according to the date of the first visit and the clinical profiles were compared between the 1990s group (25 eyes in 18 patients, 9 men and 9 women) and the 2000s group (24 eyes in 16 patients, 13 men and 3 women). Results: The age of onset and uniocular/biocular ratio did not differ between the two groups. More cases we re complicat e d with ex t raocular tuberculosis in the 1990s group (50% in the 1990s group vs 12.5% in the 2000s group). In the 1990s gro u p , retinal peri p h l ebitis (72.2%), ch o roidal tuberculoma (5.6%), multifocal ch o roiditis (5.6%) and panu veitis (16.7%) were observe d, but all cases presented with retinal p e ri p h l ebitis in the 2000s group. The perc e n t age of pat i e n t s who underwent antituberculosis tre atment and oral cort i c o st e roid therapy did not differ between the two gro u p s , but more cases we re conducted the laser photocoag u l ation and the perc e n t age of patients who re q u i red a vitre c t o my was lower in the 2000s group. Furt h e rm o re, the perc e n t age of eyes with good visual acuity (better than 20/20) increased (38% in the 1990s group vs 87.5% in the 2000s group). Concl u s i o n s : Th e clinical outcomes in patients with ocular tuberculosis we re i m p roved during the 2000s, wh i ch may be at t ri buted to the results of active laser photocoag u l ation therapy. Financial fundings: None Conflict of interest: None Keywords: tuberculosis, uveitis, prognosis
PO3-26-04 EPIDEMIOLOGIC RELATIONSHIP BETWEEN FUCHS HETEROCHROMIC IRIDOCYCLITIS AND THE UNITED STATES RUBELLA VACCINATION PROGRAM Tessler Howa rd H (Unive rsity of Illinois at Chicago ) Birnbaum D Andrea (University of Illinois at Chicago), Goldstein A Deb ra (Unive rsity of Illinois at Chicago ) , Schultz A Kara (University of Illinois at Chicago), Farber D Marilyn , Lin Phoebe (University of Illinois at Chicago) Introduction: We studied the epidemiologic association between Fuchs heterochromic iridocyclitis (FHI) and rubella vaccination in the United States. Methods: The percentages of patients with FHI, idiopathic chronic iridocyclitis(CIC) and chronic granulomatous iridocyclitis (CGI) at the University of Illinois were compared over time. Analysis of country of origin (US versus foreignborn) was also performed. Findings were correlated with implementation of the rubella vaccination program in the US in 1969. Results: 3856 patients were seen between 1985 and 2005. Percentages of patients with FHI and CGI born between 1919 and 1958 were similar (FHI:3.51-5.19%); CGI:3.51-4.72%), with more variability in CIC:(6.63-11.32%). A 64.8% reduction in FHI subjects was seen for those born the following decade (1959-1968). An additional 39.7% drop in FHI occured in patients born between 1969 and 1978. Only 1 patients with FHI was born during the decade 1979-1988. The trend over time for FHI differed significantly from CIC (p=0.0007) and CGI (p=0.0002) with no difference between the controls (p=0.5437). The percentage of foreign-born patients with FHI increased after the institution of the rubella vaccination program (42-55%) compared to those born in previous decades (24-25%). This was not observed in the controls. Conclusion: FHI is less common in patients born since the introduction of the US rubella vaccination program with a corresponding increase in the percentage of foreign-born cases. This epidemiological study supports a relationship between the rubella virus and FHI. Financial fundings: none Conflict of interest: none Keywords: Fuchs Heterochromic Iridocyclitis, Rubella, rubella vaccination
PO3-26-05 A NEW EPIDEMIC OF ACANTHAMOEBA KERATITIS Wilhelmus Kirk R (Baylor College of Medicine) Introduction and Objectives: Acanthamoeba keratitis, first 9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 183
Abstract Book recognized in 1973, emerged as a public health problem 20 years ago because of inadequate contact lens disinfection and storage. With improved education on proper lens care, its incidence subsequently declined and stabilized at less than five per million per year, although the epidemiology of Acanthamoeba keratitis varied among different countries. In the United Sat e s , t wo regional wat e r- re l ated outbreaks recently occurred: one took place from 1994 to 1996 associated with flooding in Iowa and another began in 2004 linked to community water supplies in Illinois. In parallel with the ongoing outbreak in Chicago, other U.S. metropolitan centers have also noticed a recent upsurge of this protozoal infection. Methods: I rev i ewed the epidemiology of Acanthamoeba keratitis at our referral center in Texas over the past decade and examined risk factors and outcome. Results: Forty-five eyes with A c a n t h a m o eba ke ratitis, including two patients with bilateral keratitis, were confirmed by culture isolation (42) or histopathological biopsy (3) from mid-1997 to mid-2007, with a slight peak in the spring season. The annual number of cases ranged from 0 to 5 per year from 1997 to 2003 but then abruptly increased to 12 cases during 2004 and continued to occur at 5 to 8 cases per year from 2005 to the present. Contact lens wear preceded 96% of infections, and Acanthamoeba species could be recovered from the lens storage case. After antiprotozoal therapy with a diamidine (hexamidine or propamidine) and a biguanide (chlorhexidine or polyhexanide), half achieved vision of 20/40 (6/12) or better with medical therapy alone. Penetrating keratoplasty was performed for 30% of eyes. Conclusion: Acanthamoeba ke ratitis re - e m e rged during 2004 to 2007, predominantly among soft contact lens wearers. Lens care products, domestic tap water, and other sources of environmental contamination are under investigation in this new outbreak.
DESIGN: Longitudinal study Methods: patients were examined if they had a positive IgM antibody test for toxoplasmosis. Follow up examinations we re performed after 1, 4 and 7 months. RESULTS: serological examinations were performed in 3868 individuals, being 562 IgM positive for T.gondii. From the total, 49% were male and age ranged from 5 days to 88 years. Systemic symptoms of t. gondii infection were present in 86.47% of the patients. From the 562 examined patients, 5 (0.88%) received treatment for toxoplasmosis before the eye examination and 11 (1.95%) were treated after the ocular examination (all of them with the association of sulphdiazine and pirimethamine). Twelve patients developed eye lesions. CONCLUSION: We found the association of 12% of patients that developed concomitante ocular and systemic infection from an T. gondii outbreak
Financial fundings: None Conflict of interest: None Keywords: Epidemiology, Infection, Contact lens
Methods: A retrospective review of all consecutive patients who attended Aberdeen Royal Infirmary Eye department for ocular inflammatory conditions over a six-month period.
PO3-26-06 A LONGITUDINAL STUDY OF OCULAR INVOLVEMENT IN AN EPIDEMIC OF TOXOPLASMA GONDII INFECCION Muccioli Christina (Federal University of Sao Paulo), Belfort Jr Rubens Claudio (Fe d e ral Unive rsity of Sao Paulo), Holland Gary (University of California-Los Angeles), Jones Jeffrey (CDC-Atlanta) PURPOSE: to evaluate the incidence of ocular toxoplasmosis during the first 8 months of an epidemic of T.gondii infection and to evaluate changes in ocular findings over time.
Financial fundings: none Conflict of interest: none Keywords: OUTBREAK; TOXOPLASMOSIS; UVEITIS
PO3-26-07 OCULAR INFLAMMATORY DISEASE IN A TERTIARY REFERRAL CENTRE IN SCOTLAND Ho Su Ling (Department of Ophthalmology, Aberdeen Royal Infirmary Scotland and Tan Tock Seng Hospital Singapore), Olson John (Department of Ophthalmology, Aberdeen Royal I n fi rm a ry Scotland), Forrester V John (Department of Ophthalmology, Aberdeen Royal Infirmary Scotland) Introduction and Objectivies: To study ocular inflammatory disease epidemiological profile in a Scottish uveitis tertiary referral centre.
Results: Th e re we re 462 cases re c o rded with 98% of Caucasian origin. The mean age of presentation was 40Âą0.9 year and the mean duration of follow-up was 7.3Âą0.4 years. Anterior uveitis(34%, n=145) was the commonest form encountered, followed by panuveitis(26%, n=110), posterior uveitis(18%, n=78), intermediate uveitis(15%, n=63) and scleritis(7%, n=30). Infectious aetiologies were found in 10.1%(n=43). 30.3%(n=129) of cases were associated with confirmed systemic diseases and 8.7%(n=37) were linked to presumed systemic disorders. 19.7%(n=84) were classified under specific ocular diseases, which were well described but idiopathic in nature. 30.3%(n=129) had an undetermined aetiology. Sight-threatening complications like cystoid macular oedema (25.0%), cataract(25.1%) and glaucoma(16.9%)
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 184
Abstract Book were common. 68.1% of cases had received systemic corticosteroid therapy. Additional systemic immunosuppressive therapies were required in at least 30% of cases. Bilateral visual loss (equal or less than 6/18) occurred in 11% of cases and 28.2% had unilateral visual loss. There was no statistically significant difference in the percentage of cases suffering from visual loss, between the determined and undetermined aetiological diagnosis groups. Conclusions: Infection is an important cause of inflammatory eye disease. There was no significant diversity between the visual prognosis of established uveitis diagnosis with those of undetermined aetiologic diagnosis. The need to address the risk of sight-threatening complications is as critical as establishing an accurate diagnosis for planning the correct therapeutic approach. Financial fundings: Nil Conflict of interest: Nil Keywords: Ocular inflammatory disease, uveitis, epidemiology
PO3-26-08 EPIDEMIOLOGY AND CLINICAL COURSE OF UVEITIS IN TURKEY Akova Yonca A. (Department of Ophthalmology, Ba_kent University, Faculty of Medicine, Ankara, Turkey) Sizmaz Selcuk (Department of Ophthalmology, Ba_kent University, Faculty of Medicine, Adana, Tu rkey ) , G u n gor Sirel G. (Department of Ophthalmology, Ba_kent University, Faculty of Medicine, Ankara, Turkey) Oktem Caglar (Department of Ophthalmology, Ba_kent University, Faculty of Medicine, A n k a ra , Turkey), Altan-Yaycioglu Rana (Department of Ophthalmology, Ba_kent University, Faculty of Medicine, Adana, Turkey) Introduction and objectives: To investigate the demographic, etiological and clinical features of uveitis patients foll owed-up at Ba_kent Unive rsity, S chool of Medicine, Department of Ophthalmology. Methods: Medical charts of patients who were diagnosed with uveitis between 1996 and 2006 was rev i ewed. Descriptive analysis of age, gender, family history, ophthalmologic examination, laboratory findings and therapeutically approaches for each patient was made. Results: A total of 275 patients were included in the study group; 158 (54.45%) were females and 117 (42.55%) were males, aging between 5 and 83 (43.94 ± 17.28). The mean duration of the disease was 3.56 ± 5.07 years. Behçet’s disease was found to be the main cause of uveitis in the study
group (23.27%), followed by Fuchs’ uveitis (8.73%), ankylosing spondylitis (8.36%), tuberculosis (6.18%), sarcoidosis (4.73%), herpetic uveitis (4.73%), toxoplasmosis (4.0%) and other causes. In 17.82% of cases no etiological factor could be detected. Anterior uveitis was the most common presentation (46.18%), followed by panuveitis (35.27%). Most cases tended to present bilaterally (54.55%). In males 26 – 40 were the most common ages for uveitis presentation; whereas uveitis cases predominantly occurred between 41 – 60 years. Fundus fluorescein angiography was most commonly used method in the diagnosis of uveitis. Topical corticosteroid was a d m i n i s t e red in 87.64% of patients; 44.0% of patients received systemic corticosteroid therapy and 50.41% of these were combined with immunosuppressive agents; whereas 16.36% of patients received immunosuppressive therapy alone. _ntravitreal steroid injection was performed in 8% of patients. Conclusion: Uveitis, as having severe ocular complications, needs to be evaluated by a multidisciplinary collaboration. Thorough evaluation is important in order to identify demographic, etiological and clinical features and for better ocular and social rehabilitation of patients. Financial fundings: None Conflict of interest: None Keywords: Etiology, demography, uveitis
PO3-26-09 PATTERN OF CHILDHOOD UVEITIS IN A REFERRAL CENTER IN TURKEY Ozdal Pinar C, Berker Nilufer, Kavuncu Sevim, Taskintuna Ibrahim, Koklu Gultekin (Ulucanlar Eye Hospital) Introduction and Objectives: This study aimed to investigate the frequency and characteristics of childhood-onset uveitis and evaluate the rate and specific causes of visual loss in this population. Methods: The data of 92 patients (147 eyes) with uveitis starting before 18 years and followed-up for at least 6 months were retrospectively evaluated. Age at onset, sex, laterality, a s s o c i ated systemic disease, l ab o rat o ry dat a , therapeutic strategies, surgeries, final visual acuity and causes leading to visual acuity 0.1 were analyzed. Results: Childhood-onset uveitis made up 10% of our uveitis patients. The mean age at onset was 12.2 (4-17) years and the mean follow-up period was 44.7 (6-128) months. Sixty (65.2%)of patients were male. The disease was bilateral in 55 (59.8%) patients. Uveitis was mostly (59.8%) seen between 12-17 years of age . Pars planitis, observed in 23 (25%) patients, was the leading cause of childhood-onset uveitis.
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Abstract Book Uveitis was idiopathic in 17 (18.4%) patients. The most frequently associated diseases were Behcet’s disease (BD) in 20 (21.7%) toxoplasmosis in 13 (14.1%) and juvenile rheumatoid arthritis (JRA) in 7 (7.6%) patients. Anterior uveitis was observed in 15 (16.3%), intermediate uveitis in 24 (26.1%), posterior uveitis in 26 (28.3%) and panuveitis in 27 (29.3%) patients. Visual acuity was 0.1 in 31 eyes (21.1%) of 26 patients (28.3%. Of these 26 patients, 13 had BD (50%), 5 had idiopathic uveitis (19.2%), 3 had JRA (11.5%), 2 had macular scar due to retinochoroiditis (7.7%), 2 had pars planitis (7.7%) and 1 had toxocara (3.8%). Optic atrophy was the main cause of visual loss and has been observed in 13 eyes (41.9%). Conclusions: Childhood-onset uveitis has a blinding potential and causes to visual loss in up to 28 % of the patients. In our country, BD associated uveitis is the leading cause of visual loss in childhood uveitis as an adulthood. Financial fundings: None Conflict of interest: None Keywords: childhood, pediatric, uveitis
PO3-26-10 CAUSATIVE SPECTRUM OF HYPERTENSIVE ACUTE UVEITIS KALOGEROPOULOS CHRIS D (UNIVERSITY EYE CLIN IC OF IOANNINA, GREECE), FLINDRI VASILIKI (UNI VERSITY EYE CLINIC OF IOANNINA, GREECE), VRIONI S GEORGIA (LABORATORY OF MICROBIOLOGY, UNI VERSITY OF IOANNINA, GREECE), MALAMOU-MITSI D VASILIKI (DEPARTMENT OF CYTOPATHOLOGY, UNI VERSITY OF IOANNINA, GREECE), LEVIDIOTOU STA MATINA (LABORATORY OF MICROBIOLOGY, UNIVER SITY OF IOANNINA, GREECE) Introduction and objectives: Among patients pre s e n t i n g uveitis there are cases ch a ra c t e ri zed by acute invasion of i n fl a m m at o ry sings and acute rise of intraocular pre s s u re, wh i ch seems to re flect an infl a m m ation of trabecular regi o n . The aim of our study was the diffe rential diag n o s i s , with regard to the etiology, of hy p e rt e n s ive acute uve i t i s . Methods: Patients presenting anterior uveitis along with ocular hy p e rtension (without anteri o r / p o s t e rior synechiae or anterior chamber angle neova s c u l a ri z ation) we re included in a prospective study between Ja nu a ry 2001 and December 2006. I n clusion cri t e ria we re the acute ap p e a rance of clinical signs and the sudden invasion of symptoms re fe rred by thepat i e n t s . The diffe rential diagnosis was based on the history, clinical signs and lab o rat o ry tests (sero l ogy tests, aqueous cy t o l ogy and aqueous PCR included) for the diagnostic ap p ro a ch of uveitis. Concerning the PCR technique perfo rmed DNAs we re amplified using a new type of primer system, “stair
primer”, in a single consensus PCR, b ri n ging simultaneous amplifi c ation of the six commonest herpesviruses: herpes simplex virus 1 and 2 (HSV1, HSV2), va ri c e l l a - zoster viru s (VZV), cytomega l ov i rus (CMV), Epstein-Barr virus (EBV) and human herpes virus 6 (HHV-6). Results : In 38 patients clinical and laboratory investigation revealed a variety of causes of hypertensive acute anterior uveitis (HSV:10 cases, VZV:3, EBV:1, CMV:1, Toxocara canis:1, Toxoplasma gondii:2, Toxoplasma +CMV:1, “presumed” TBC-uveitis:2, TBC-uveitis:1, regional infection:2, phacoanaphylactic reaction:2, infectious endophthalmitis:1, Fuchs’ heterochromic cyclitis:3, Posner-Schlossman syndrome:5, uveitis of unknown origin:3). Cases caused by Toxocara, Toxoplasma and CMV experienced a posterior segment involvement as well. Conclusions: In a considerable proportion, almost 40% of our cases with acute anterior uveitis and ocular hypertension, herpesviruses were the causative agent (in majority HSV1). Cases presenting Posner-Schlossman syndrome were not ra re. Aqueous humor ex a m i n ation using PCR for herpesviruses and serology tests are significant diagnostic methods for the differentiation of difficult clinical cases. Investigation also revealed causes of acute hypertensive uveitis not generally considered as common. Financial fundings: No fundings for this research. Conflict of interest: No conflicts of interest. Keywords: Hypertensive uveitis, herpesviruses, aqueous PCR
PO3-26-11 UVEITIS PRESENTING FOR THE FIRST TIME IN THE ELDERLY Jakob Eva (Interdisciplinary Uveitis Center, Heidelberg) M a ckensen Fri e d e ri ke (Interdisciplinary Uveitis Center, Heidelberg), Max Regina (Interdisciplinary Uveitis Center, Heidelberg), B e cker Matthias (Interd i s c i p l i n a ry Uveitis Center, Heidelberg) Introduction: This study aimed to describe the clinical characteristics of uveitis presenting de novo in the elderly. Methods: We retrospectively examined 144 patients with uveitis presenting with their first episode of uveitis at the age of 60 years or more who attended the Interdisciplinary U veitis Center Heidelberg between 2001 and 2007. Results: The median age of onset of uveitis was 66 years. Of the 144 patients 102 (71%) were female and 42 (29%) were male. The localisation of uveitis was anterior in 41% of patients, intermediate uveitis was diagnosed in 21% of patients, posterior uveitis was found in 14% and panuveitis in 7% of patients. In 17% of patients an extrauveal infection was diag-
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 186
Abstract Book nosed. Systemic disease was observed in 23%, with sarcoidosis (9 patients, 6%) being the most frequent. The underlying cause of uveitis was evaluated as infectious in 18% of cases, whereas herpes viruses were the most common infection (16 patients, 11%). Ocular syndromes were diagnosed in 10% of patients. Conclusion: The prevalence of sarcoidosis and herpetic infections was higher in older uveitis patients than in younger patients in our cohort. The anatomical localization of uveitis in older patients was similar to those of younger persons. Financial fundings: None Conflict of interest: None Keywords: uveitis, elderly, epidemiology
PO3-28-01 POSTERIOR SEGMENT RECURRENCES IN VOGTKOYANAGI-HARADA DISEASE S a ch d ev Nishant (Post Gra d u ate Institue of Medical Education and Research, Chandigarh), Gupta Vishali (Post G ra d u ate Institue of Medical Education and Research , Chandigarh), Gupta Amod (Post Gra d u ate Institue of Medical Education and Research , Chandigarh), Singh Ramandeep (Post Graduate Institue of Medical Education and Research, Chandigarh), B a m b e ry Pra d e ep (Post G ra d u ate Institue of Medical Education and Research , Chandigarh) The Vogt-Koyanagi-Harada (VKH) disease is a bilateral granulomatous panuveitis characterized by ocular, neurological and integumentary involvement.Recurrences in VKH disease usually involve the anterior segment, predominant posterior segment recurrences with serous retinal detachment are uncommon. We describe the clinical profile, management and outcome in seven patients with posterior segment recurrence in Vogt-Koyanagi - H a rada (VKH) disease. Material and Methods: Retrospective chart review of all the patients of VKH disease presenting to our institute between 2001 to 2005 was done. Patients with a documented posterior segment recurrence during follow-up were included in this study. Their history, systemic associations, ocular findings, inve s t i gations, management strat egies and tre at m e n t response were noted. Results: Out of 82 VKH patients screened, documented posterior segment recurrence was seen in 7 patients who included 5 women and 2 men with a mean age of 33.7 years (range 22-55 years). At the onset, two patients received diagnosis of incomplete and 5 probable VKH disease as per the revised criteria of VKH disease. At the time of recurrence, 4 patients were on maintenance dose (5-10 mg/day) of oral corticosteroid while the remaining 3 were off treatment. The mean
interval between the primary episode and posterior segment recurrence was 33.7 weeks (range 16 weeks- 52 weeks). All posterior segment recurrences were bilateral and were characterized by vitritis (8 eyes), papillitis (14 eyes), multiple yellow-white oval subretinal lesions (6 eyes) and exudative retinal detachment (11 eyes). The recurrences were managed with oral corticosteroids (1.0-1.5mg/day) and Azathioprine (2.0 - 2.5 mg/day). Subsequently, three patients experienced a second episode of posterior segment recurrence, which also responded to the corticosteroid-Azathioprine combination. Conclusions: Recurrences in VKH disease may involve predominantly the posterior segment, and responds well to the standard treatment. Financial fundings: None Conflict of interest: None Keywords: VKH disease, Fundus Fluorescein angiography, Ultrasonography
PO3-28-02 EARLY DIAGNOSIS AND THE VISUAL PROGNOSIS OF VKH HONG LU (Dept of Ophthalmology ,Beijing Chaoyang Hospital,Capital of Medical Sciences) Objective: To Investigate the relationship between early diagnosis and the visual prognosis of VKH. Methods : 26 cases diagnosed with Vogt-Koyanagi-Harada syndrome in our Department from September 2003 to August 2005 were divided into two groups, 12 cases(24 eyes) with initial stage in group 1 and 14 cases(28 eyes) with recurrent stage in group 2. Slit-lamp microscope, indirect fundoscope, threemirror lens and fundus fluorescein angiography(FFA) were examined in all patients. Visual acuity, FFA and recurrence rate of VKH were compared between two groups after systemic glucocorticoid administration. Results: Hypopsia, pain during oculogyria,choroidoretinitis, and papilledema were noted in the patients in initial stage. Multifocal hyperfluorescence in early stage followed by localized hyperfluorescent spots in retina and fluorescence l e a k age in optic papilla were typical findings in FFA. Alopecia, poliosis, depigmentation of skin, recurrent granulomatous anterior uveitis, posterior synechia, mutton fat K P Å C D a l e n - F u chs nodules, sunset glow fundusÅCpapilloedema were common findings in recurrent stages. Leakage of fluorescence from papilla vessels, transmitted fluorescenceÅCand moth-like appearance are common FFA findings. The 2=22.09,Pvisual acuity (<0.01) are s i g n i fi c a n t ly better and 2=4.02, Pre c u rrence rateÅi<0.05Åjare much lower in initial stage than those in control group.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 187
Abstract Book Conclusion: Visual acuity of the patients in recurrent stages was significantly lower than that in initial stage despite of the same treatment with systemic glucocorticoid. Early diagnosis and systemic treatment in initial stage of VKH syndrome are important to visual prognosis. Financial fundings: None Conflict of interest: None Keywords: Vogt-Koyanagi-Harada syndrome, early diagnosis,visual prognosis
PO3-28-03 LONGITUDINAL QUANTIFICATION OF AQUEOUS FLARE AND CELLS IN VOGT-KOYANAGI-HARADA SYNDROME Fang Wang (1State Key Lab o rat o ry of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China) Zhou Hongyan (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Yang Peizeng (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China) Huang Xiangkun (1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China) Wang Li (1State Key Laborat o ry of Ophthalmology, Zhongshan Ophthalmic Center, Uveitis Study Center, Sun Yat-sen University, Guangzhou, P.R. China; 2International Uveitis Study Laboratory of Guangdong Prov i n c e, Guangzhou, P.R. China) Kijlstra Aize (2International Uveitis Study Laboratory of Guangdong Province, Guangzhou, P.R. China; 3Eye Research Institute Maastricht, Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands) Objective: To quantitatively evaluate the changes of aqueous flare and cells in eyes with Vogt-Koyanagi-Harada (VKH) syndrome. Methods: This prospective study included 70 eyes of 35 initial-onset VKH patients and 92 eyes of 46 recurrent VKH patients following immunotherapy. Aqueous flare and cells were quantified using the laser flare-cell meter before treatment, 2 weeks, 1, 3, 6 and 9 months after treatment.
Results: Before treatment, mean aqueous flare values (pc/ms) were 8.1-4.1 vs. 43.6-20.7 in initial-onset and recurrent VKH eyes respectively (PĂ&#x2026;Ă&#x2026;0.000). Following treatment, recurrent VKH eyes showed a significantly higher flare value than initial-onset VKH eyes at 2 weeks, 1, 3 and 6 months. Prior to treatment, mean cell counts (cells/0.5mm3) in initial-onset and re c u rrent VKH eyes we re 2.0-1.9 vs. 39.4-23.1 (P=0.000). Following treatment, recurrent VKH eyes showed significantly higher cell counts than initial-onset VKH eyes at 2 weeks, 1 and 3 months. Conclusion: Our results showed that recurrent VKH eyes displayed a more striking and long-lasting breakdown of the BAB and more severe inflammation than initial-onset VKH eyes. Our study also indicated that the disruption of BAB lasted longer than aqueous cells either in initial-onset or in recurrent VKH eyes. Financial fundings: This study was supported in part by the Fund for Project of Science and Technology of Guangdong province (2005B60302009), Key Project of Natural Science Fo u n d ation (30630064), N ational supporting project of P.R.China and 5010 Clinical Project of Sun Yat-sen University. Conflict of interest: None of the authors has a proprietary or financial interest in any product mentioned. Keywords: Vogt-Koyanagi-Harada syndrome, laser flare cell photometry, blood-aqueous barrier
PO3-28-04 EFFECTS OF THE DURATION OF INITIAL ORAL CORTICOSTEROID TREATMENT ON THE RECURRENCE OF VOGT-KOYANAGI-HARADA DISEASE Lai Timothy Y Y (The Chinese University of Hong Kong), Chan P S Rose (The Chinese University of Hong Kong), Chan K M Carmen (The Chinese University of Hong Kong), Lam S C Dennis (The Chinese University of Hong Kong) Objectives: To evaluate the effects of the duration of oral corticosteroid treatment on the recurrence of Vogt-KoyanagiHarada (VKH) disease.
Methods: Retrospective analysis of 37 Chinese patients with VKH who received oral corticosteroid during the initial VKH episode with a follow-up duration of 6 months or more. Patients were divided into two groups based on the duration of oral corticosteroid treatment of less than 6 months or 6 months or more. Kaplan-Meier survival and Cox-regression analyses were carried out to compare the recurrence rates of VKH in the two groups.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 188
Abstract Book Results: The mean age of onset of the patients was 40 years (range, 10 to 72 years) and the mean follow-up duration was 3.3 years (range, 0.7 to 6.5 years). There were 18 males and 19 females. Six (16.2%) patients had complete VKH, 24 (64.9%) had incomplete VKH, and 7 (18.9%) had probable VKH. During the follow-up period, 9 (52.6%) of the 19 patients who received oral corticosteroid for less than 6 months compared with 2 (11.1%) of the 18 patients who had treatment of 6 months or more developed recurrence (P=0.007). Coxregression analysis showed that the duration of oral corticosteroid treatment was the only significant risk factor for recurrence of VKH after adjusted for age, gender, and the dosage of oral corticosteroid treatment (Adjusted Odds Ratio = 7.1, P=0.017). Conclusions: Early withdrawal of oral corticosteroid is associated with increased risk of recurrence of VKH. Oral corticosteroid should be tapered off slowly and maintained for at least 6 months after the onset of VKH. Financial fundings: None Conflict of interest: None Keywords: Vogt-Koyanagi-Harada Corticosteroid, Treatment duration
Disease,
PO3-28-05 CHOROIDAL VASCULAR INVOLVEMENT IN PATIENTS WITH ACUTE VOGT-KOYANAGIHARADA DISEASE Ben Yahia Salim (Fattouma Bourguiba Unive rs i t y Hospital, Monastir, Tunisia), Turki Khalil (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia), Chaouch Ahmed (Fattouma Bourguiba Unive rs i t y Hospital, Monastir, Tunisia), Hasnaoui Wafa (Fattouma Bourguiba Unive rsity Hospital, Monastir, Tunisia), Messaoud Riadh (Fattouma Bourguiba Unive rs i t y Hospital, Monastir, Tunisia), K h a i rallah Moncef (Fattouma Bourguiba University Hospital, Monastir, Tunisia) Introduction and objectives: To analyze choroidal vascular involvement in acute Vogt-Koyanagi-Harada (VKH) disease. Methods: Thirteen patients (26 eyes) with acute VKH disease were examined by fluorescein and indocyanine green (ICG) angiography.
Results: Eyes were affected as follows: choriocapillaris filling delay/defects (26; 100%), a decrease in the number of large choroidal vessels (10; 38.5%), perivascular leakage (24; 92.3%), areas of choroidal hyperfluorescence in the late phase of ICG angiography (20; 76.9%), and severe thrombosis of large choroidal vessels (2; 7.7%). Conclusions: Choroidal vasculopathy, with features of ch o roidal ischemia and vascular hy p e rp e rm e abilty, appears to be a prominent finding in patients with acute VKH disease. Financial fundings: None Conflict of interest: None Keywords: VKH, ICG angiography, choroid
PO3-28-06 THE SPECTRUM OF VOGT-KOYANAGI-HARADA DISEASE IN TUNISIA, NORTH AFRICA Jelliti BĂŠchir (Fattouma Bourguiba University Hospital Monastir Tunisia), Zouid Sonia (Fattouma Bourguiba University Hospital Monastir Tunisia), Brahem Darine (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia), Aya chi Mariem (Fattouma Bourg u i b a University Hospital Monastir Tunisia), Messaoud Riadh (Fattouma Bourguiba Unive rsity Hospital Monastir Tunisia), K h a i rallah Moncef (Fattouma Bourg u i b a University Hospital Monastir Tunisia) Introduction and objectives: To analyze the clinical p ro file of Vog t - Koya n agi - H a rada (VKH) disease in Tunisia, North Africa. Methods: We re trospectively rev i ewed the clinical records of 49 patients diagnosed with VKH disease at the Dep a rtment of Ophthalmology of Fattouma B o u rguiba Unive rsity Hospital, Monastir, Tunisia, between January 1994 and September 2005. Results: Of all the uveitis cases diagnosed during the study period, VKH disease was the fourth most commonly occurring type (7.4%). Thirt y - t wo patients (65.3%) were female, and 17 patients (34.7%) were male. The mean age at disease onset was 35 years (range: 16-54 years). The majority of patients (51%) had probable VKH disease, followed by incomplete type (47%); only 2% had the complete type. At presentation, 47 patients (96%) had bilateral ocular involvement. Clinical presentation was a panuveitis in 25
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 189
Abstract Book patients (51%) and a posterior uveitis in 24 patients (49%). Visual acuity (VA) at presentation ra n ged fro m less than 20/200 (40.8%) to more than 20/40 (28.5%). All patients we re tre ated with systemic cort i c o s t e ro i d s for 2-19 months (mean: 10.5 months). Four patients (8%) we re tre ated with cy cl o s p o rin because of seri o u s systemic side effects of cort i c o s t e roids. Complicat i o n s i n cluded cat a ract in 18 eyes (33.9%), glaucoma in nine eyes (16.96%) and ch o roidal neova s c u l a ri z ation in one eye (1%). Fifty-eight eyes (59%) had a final VA of 20/40 or better. Fa c t o rs associated with a poor VA at the final follow-up we re the presence of a poor VA at presentation (P = 0.02), the occurrence of complications (P = 0.001) and/or recurrences (P = 0.02). Conclusion: In Tunisia, VKH disease is a common cause of uveitis that pre d o m i n a n t ly affects young women. The overwhelming majority (98%) have probable or incomplete VKH disease, presenting as panuveitis or posterior uveitis. More than 50% of patients undergoing treatment with corticosteroids will maintain a VA of 20/40 or better. Financial fundings: None Conflict of interest: None Keywords: Vogt-Koyanagi-Harada, Epidemiology, Management
PO3-29-01 ABNORMAL CELLULAR REACTIVITY TO MICROBIAL ANTIGENS IN PATIENTS WITH UVEITIS Ract Madoux Guillaume AS (Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyo n , France), Cozon J Grégoire (INSERM U851 Université Lyon 1, IFR 128, HCL: 69365 Lyon, France. UFR Lyon-Nord Unive rsité Lyon 1 69), Nbitiki F Martial (INSERM U851 Université Lyon 1, IFR 128, HCL: 69365 Lyon, France. UFR Lyon-Nord Université Lyon 1 69), Spire Myriam (Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France) Gra n ge Jean-Daniel (Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices C ivils de Lyon, Lyon, Fra n c e ) , Kodjikian Laurent (Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France) Purpose: The aims of the present study were to evaluate the cellular response to microbial antigens in
patients with idiopathic uveitis. Methods: Blood lymphocytes from 31 patients with uveitis and 24 healthy controls were cultivated with microbial antigens and analyzed in flow cytometry after staining with monoclonal antibodies against CD3, CD4, and activation markers CD69 and CD25. Results: Although no difference was noted in circulating lymphocytes, activation of T-cells, detected with CD69, was higher in a 24-hour blood culture from uveitis patients with Candida albicans antigen (Ca-Ag) when compared to controls, especially in posterior uveitis and panuveitis. Moreover late response, detected with CD25, to different microbial antigens was higher in patient with uveitis. Conclusions: Such results suggest the role of Ca-Ag and microbial antigens in the pathogenic mechanisms of idiopathic uveitis. Financial fundings: HCL jeune chercheur clinique 2001 Conflict of interest: NONE Keywords: antigens, uveitis, candida
PO3-29-02 ELECTROPHYSIOLOGICAL FEATURES OF MULTIPLE EVANESCENT WHITE DOT SYNDROME Popovic Petra (Eye Clinic Ljubljana, Slovenia), Kraut Aleksandra (Eye Clinic Ljubljana, Slovenia), Brecelj Jelka (Eye Clinic Ljubljana, Slovenia) Introduction: Multiple evanescent white dot syndrome (MEWDS) is mostly a unilateral transient chorioretinopathy affecting young women with antecedent flu-like disease. Due to its benign nature a thorough electrophysiological examination is not routinely performed. The aim of the study was to show some atypical electrophysiological features of MEWDS in acute and later in convalescent phase of the disease and relate them to angiographic and clinical findings. Methods: In six patients with a clinical diagnosis of MEWDS Goldmann and Octopus visual fields were performed and fluorescein angiography was done. Fullfield ERGs, pattern ERGs, multifocal ERGs and VEPs were recorded using ISCEV standards and guidelines.
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 190
Abstract Book Electrophysiology was performed twice - at the time of diagnosis and after the resolution of symptoms at least 3 months later . Results: All 6 patients were young women aged 21 - 38. They all had monocular visual loss (visual acuity ranging from 0.2 to 0.6) and central scotoma or enlarged blind spot on the affected eye. Fluorescein angiography showed discrete hyperfluorescent dots on posterior pole and mid-periphery. At the first visit mfERGs were reduced in all patients, corresponding to visual field defects. PERGs and full-field ERGs were decreased in all but one patient. Scotopic responses were affected more than photopic in 3/5 patients. In the follow-up period visual acuity returned to normal in 5/6 patients, but electrophysiology only in 2/6. Conclusions: In a retrospective case series of 6 patients with MEWDS we show that despite mild visual symptoms in the acute phase of the disease electrophysiology findings may show more generalized depression of the retinal function. The recovery of function may not be complete or it may take longer than expected solely on clinical signs. Financial fundings: None Conflict of interest: None Keywords: MEWDS, multifocal electroretinography, fluorescein angiography
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Abstract Book Abbas Zahir Abbas Zahir Abbas Zahir Abboud B. Emad Abdulaziz Randa Abdulaziz Randa Abi-Ayad Neil Abreu T Mariza Abreu T Mariza Abreu T Mariza Abreu T Mariza Abu El-Asrar Ahmed Abu El-Asrar Ahmed Abu El-Asrar Ahmed Accorinti Massimo Accorinti Massimo Accorinti Massimo Acevedo Sarah Adamis Anthony P. Adamus Grazyna Adamus Grazyna Adatia Fiesal Adenis Jean-Paul Adnani Kamla Aggos Ioannis Aggos Ioannis Aggos Ioannis Aguinaga-Barrilero Ana Ahmedi L Mohammed Ahmedi Laid Mohammed Aize Kijlstra Aize Kijlstra Aize Kijlstra Akaishi M S Patricia Akanuma Masataka Akesbi Jad Akova Yonca A. Akpek Esen Akritopoulos Panagiotis Akritopoulos Panagiotis Akritopoulos Panagiotis Akritopoulou Kiriaki Akritopoulou Kiriaki Akritopoulou Kiriaki Akyurek Nalan Al Youssef Abir Alarbi Mohammad Al-Arfaj Abdulrahman Aldibhi Hassan Aldibhi Hassan Alencar M Victor Al-Fraykh Hamad Alio L Jorge Alio L Jorge Al-Kharashi S. Abdullah Allegri Pia Allegri Pia Al-Mezaine Hani Altan Simge Altan-Yaycioglu Rana Altinkurt Emre Amar Nawel Amaro H Miguel Amaro H Miguel Amaro H Miguel Amaro H Miguel Amer Radgonde Amer Radgonde Ammari Wafa Ammari Wafa Amselem Luis Amselem Luis
RF2-23 PO2-15-07 RF1-17 OP3-04 OP2-04 PO2-30-04 OP7-06 PO2-23-02 PO2-11-01 PO2-11-02 PO2-11-03 OP3-04 OP6-01 OP8-08 OP2-11 PO2-30-04 RF2-11 PO1-01-10 P12-2 OP1-07 OP1-08 PO3-21-05 OP5-03 PO3-19-04 PO1-03-03 PO1-03-04 PO1-03-06 OP9-08 PO1-04-09 PO1-05-07 PO1-02-03 OP3-05 OP3-06 P19-1 PO2-13-19 RF2-1 PO3-26-08 OP5-02 PO1-03-03 PO1-03-04 PO2-13-08 PO1-03-04 PO1-03-03 PO2-13-08 PO3-20-08 OP5-03 PO2-11-10 OP3-04 OP8-08 OP3-04 P19-7 OP8-08 PO1-03-14 PO2-13-11 OP8-08 OP11-07 PO2-09-02 OP6-01 PO3-20-05 PO3-26-08 RF1-4 PO2-13-07 PO2-23-02 PO2-11-01 PO2-11-02 PO2-11-03 PO1-22-04 PO1-02-05 PO1-02-07 PO2-09-03 PO2-15-06 PO3-24-06
Amselem Luis Andrade E Rafael Andrade E Rafael Andrade Rafael Andres Maria Luisa Angioi Karine Angioi Karine Antonio Mastromarino Anzaar Fahd Aoki Koki Aoki Koki Aouizerate Franck Aras Gülseren Arbour Jean-Daniel Ardan Taras Ardila Benjamin Arellanes Lourdes Arellanes Lourdes Arevalo J. Fernando Arevalo J. Fernando Arevalo J. Fernando Arif Mansoor Ariga Toshihide Arimura Eiko Arimura Eiko Ariyama Akiko Arruga Ginebreda Jorge Arsene Sophie Astam Neslihan Asyari Fatma Asyari Fatma Atambay Metin Ates? Halil Ates Halil Atilla Huban Attas-Fox Liat Attia Sonia Attia Sonia Attia Sonia Attia Sonia Attia Sonia Aubakirova Aigul Avni Isaac Ayachi Mariem Ayachi Meriam Aycan M. Özlem Aydin Akova Yonca Ayranci Ozen Azuma Miyuki Azumi Atsushi Baarsma S G Baarsma Seerp G Babu Kalpana Baccouri Raoudha Bagdoniene Rasa Bagdoniene Rasa Baglin G. Baglivo Edoardo Baird Paul N Bajaire Gomez Boris Josue Bajaire Gomez Boris Josue Bajaire Gomez Boris Josue Bakunowicz-Lazarczyk Alina Baldeschi L. Bambery Pradeep Bambery Pradeep Bambery Pradeep Bambery Pradeep Bansal Reema Barathan V. Barequet Irina S. Barkia Imen
PO3-24-07 RF1-20 OP8-11 OP6-04 PO1-01-03 PO1-01-07 PO1-01-08 OP11-07 PO2-13-17 PO2-13-19 PO2-13-20 PO2-15-04 PO3-19-09 PO2-15-01 PO2-13-06 RF2-16 P1-3 P15-7 P15-8 P21-3 P22-4 PO2-13-17 PO2-13-19 PO2-30-03 PO3-21-04 PO1-04-13 PO1-04-04 PO2-10-11 PO2-11-13 P11B-2 PO3-21-21 PO3-21-24 RF1-3 RF2-18 OP5-05 RF1-6 PO2-13-14 PO2-13-15 PO2-23-18 PO3-16-05 RF2-19 PO1-03-12 RF1-6 PO3-28-06 PO1-04-10 PO3-21-24 PO1-04-11 OP10-05 OP5-14 PO3-21-20 OP11-05 P24P25-1 PO3-21-01 PO1-04-08 PO1-01-12 PO2-23-22 PO2-10-09 OP7-04 P8-2 PO2-08-01 PO2-12-01 PO2-27-01 PO2-13-05 RF2-3 RF2-5 RF2-10 OP8-10 PO3-28-01 RF2-5 PO2-23-09 S4-3 PO2-13-12
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Barkia Imen Barros Ana Carolina Batellier L Batioglu Figen Batioglu Figen Batıoglu Figen Baudouin Christophe Baudouin Christophe Baudouin Christophe Baudouin Christophe Baudouin Christophe Becker D Matthias Becker D Matthias Becker Matthias Becker Matthias Becker Matthias D. Bedane Christophe Behar-Cohen F. Behar-Cohen F Behar-Cohen F Behar-Cohen F Behar-Cohen Francine Behar-Cohen Francine Behar-Cohen Francine Belfort Jr Rubens Belfort Jr Rubens Belfort Jr Rubens Belfort Jr Rubens Belfort Jr Rubens Belfort Jr Rubens Belfort Jr Rubens Belfort Jr Rubens Belfort Jr Rubens Claudio Belfort Rubens Jr N Belguendouz Houda Ben Amor Hajer Ben Amor Hajer Ben Yahia Salim Ben Yahia Salim Ben Yahya Salim Ben Yahya Salim Ben Yahya Salim Benezra David Benezra David Benezra David Benezra David Benhamou Robert Benhamou Robert Benlian Pascale Benlian Pascale Benyamini Oren Berger Claire Berker Nilufer Berthout A. Bessyo Hiroaki Betermiez P. Bettaieb Abdelbasset Bhartiya Prashant Bhat Pooja Bigey P Bigey P. Bijl H. Bilak emsettin Billotey Claire Binder Susanne Binquet Christine Birnbaum D Andrea Bloquel C Bloquel C Bochot Amélie Bochot Amelie Bochot Amélie
PO3-19-10 PO2-15-10 PO3-20-07 PO2-11-13 PO3-18-04 PO1-04-03 OP5-06 OP6-06 S8-2 PO2-11-04 PO2-13-07 PO2-11-07 PO3-20-02 OP7-05 PO3-26-11 P1-2 OP5-03 OP4-03 P17-6 P17-7 P5-2 P17-4 P17-5 PO3-17-08 RF1-20 OP6-04 OP7-08 PO2-11-02 PO2-23-11 OP7-09 OP8-05 OP8-11 PO3-26-06 PO2-15-10 PO1-05-07 PO2-13-12 PO3-16-05 RF2-19 PO2-09-03 OP2-06 PO2-23-16 PO3-28-05 P1-6 S3-5 P17-6 P17-7 PO2-23-28 PO3-18-03 OP4-02 OP4-01 RF1-6 OP3-08 PO3-26-09 PO2-10-09 PO3-21-20 PO2-10-09 PO2-23-14 RF2-4 PO2-13-17 P17-6 P17-7 RF2-3 PO3-21-24 RF1-9 PO3-21-06 OP2-01 PO3-26-04 P17-6 P17-7 PO3-17-08 P17-4 P17-5
Abstract Book Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Bahram Bodaghi Barham Boiardi Luigi Boldrini Enrico Boldrini Enrico Bolivar De Miguel Gema Bonafonte Sergio Bora Nalini S Bora S Nalini Bora S. Puran Bossy-Nobs Leila Bouchenaki Nadia Bouchenaki Nadia Bouillet Laurence Bouillet Laurence Bouladi Majda Bouladi Mejda Bouraoui Rym Bourges Jean-Louis Bowman Edward P. Bozzoni-Pantaleoni Francesco Bradstreet Christophe Braga G Débora Braham Darine Brahem Darine Brandt Teixeira Carlos Brandt Teixeira Carlos Brannan Suzanne Brecelj Jelka Brézin Antoine Brézin Antoine P Brezin P Antoine Brichova Michaela Brignole-Baudouin Francoise Bringas-Calvo Ramon Briscoe Daniel Briscoe Daniel Brousseau Bénédicte Broussolle Christiane Broussolle Christiane Broussolle Christiane Broussolle Christiane Bucknall C Roger Buisson Elisabeth Burton Ben J Buscain Irene Caggiano Claudio Çalayan Osman Calder Virginia Callanan David Camelo Serge Camelo Serge Campos C Emilio
OP1-09 S1-4 P7-3 S2-4 P10-2 S6-2 OP8-07 PO1-01-09 PO3-21-17 P1-2 OP3-08 OP6-02 OP10-04 PO1-03-16 PO1-04-12 PO1-22-02 PO1-22-05 PO3-20-06 PO3-21-27 PO1-22-10 RF2-1 OP11-04 RF1-13 OP5-07 RF2-21 P27-2 P8-3 P21-1 P8-3 OP10-03 OP9-09 OP8-12 PO3-21-16 OP9-07 PO3-16-05 PO1-02-07 PO1-04-08 OP6-06 P5-4 OP2-11 PO3-21-10 PO3-17-03 PO3-19-10 PO3-28-06 OP6-03 PO2-11-09 PO1-22-04 PO3-29-02 PO2-23-30 OP11-08 OP1-02 PO2-23-03 OP6-06 PO3-19-11 OP9-04 OP9-05 PO2-13-13 PO3-18-01 RF1-9 RF2-17 OP7-06 PO2-23-27 PO3-24-11 RF2-13 OP2-07 RF2-11 PO1-04-03 P5-1 OP10-08 P17-4 P17-3 OP10-06
Campos R Wesley Canamary Fabio Cappuccini Luca Cappuccini Luca Caputo Georges Cardona Nestor Cardozo-Garcia M Carlos Cardozo-Garcia M Carlos Casado Alvaro Casado Blanco Herman Caspers Laure Caspers Laure Caspers Laure E Caspi Rachel R. Cassou Nathalie Cassoux Nathalie Cassoux Nathalie Cassoux Nathalie Cassoux Nathalie Cassoux Nathalie Cassoux Nathalie Cassoux Nathalie Cassoux Nathalie Cassoux Nathalie Cassoux Nathalie Castejon Cervero A Miguel Castellani Elena Castillo Mario Caterina Musso Cejka Cestmir Cejkova Jitka Cermàkovà Ivet Cervantes-Castañeda A Rene Cervantes-Castañeda A Rene Cervantes-Castañeda A. Rene Cervera Enrique Cervera Enrique Chaker Nibrass Chams Hormoz Chan C Chi Chan Chi-Chao Chan Chi-Chao Chan Chi-Chao Chan K M Carmen Chan P S Rose Chan W.N Clement Chan Wn Clement Chan Yiong Huak Chaouch Ahmed Chaouch Ahmed Chaouch Ahmed Chapelon Christine Charlotte Frédéric Chastagner Pasca Chaumeil C Chaumeil Christine Chauvaud D Chee K L Caroline Chee Soon Phaik Chee Soon Phaik Chee Soon Phaik Chee Soon-Phaik Chee Soon-Phaik Chemtob S Chemtob Sylvain Chen Li-Li Chen Zoe Cheng Bob Cheng Ching Li Bob Cheng Kc Arthur Chiquet Christophe Chiquet Christophe
RF1-1 PO2-10-04 OP11-04 PO3-19-06 RF2-8 PO2-23-05 PO2-23-06 OP11-03 PO1-22-03 PO1-22-03 PO1-05-08 PO3-21-10 P2-4 P5-4 P18-7 S5-2 OP8-07 P23-5 OP6-02 RF2-1 OP10-04 PO1-03-16 PO1-04-12 PO3-21-09 PO1-22-10 RF2-21 P21-7 RF2-16 PO2-09-02 PO2-13-06 PO2-13-06 OP2-07 PO1-01-11 PO2-15-11 PO1-01-10 PO2-15-09 PO3-24-06 PO1-04-08 OP3-03 PO3-19-06 P5-4 P8-1 P20-5 PO3-28-04 PO3-28-04 RF2-15 PO3-21-18 PO2-10-08 PO1-04-10 PO2-13-12 PO3-28-05 PO3-21-17 P7-4 PO1-01-08 PO3-20-07 OP5-10 P5-2 OP9-10 OP2-09 RF1-22 PO1-22-01 PO2-10-08 PO2-11-11 P5-2 PO1-05-05 PO3-18-02 P5-4 PO2-11-11 PO1-22-01 PO1-03-02 OP9-07 PO3-21-16
Chizzolini Carlo Choi Dongseok Choi John Chong Victor Choopong Pitipol Christine Fardeau Chu S David Cimaz Rolando Cimino Luca Cimino Luca Clement Ana Clermont-Vignal Catherine Cochereau Isabelle Cochereau Isabelle Cochereau Isabelle Cochereau Isabelle Cochereau Isabelle Cogne Michel Cohen Hm Jacques Cohen S Colao Lorena Colucci Annalisa Colucci Annalisa Combadière C Combadiere C. Confavreux Christian Conway D. Mandi Coscas Gabriel Coslovi Chiara Coupland Sarah E Couto A Cristobal Couto A Cristóbal Couto A Cristóbal Couto A Cristóbal Couto Cristobal Couvidat Magalie Cozon J Grégoire Crance Joelle Crane Isabel Crane Isabel Crépin Sophie Creuzot Catherine Creuzot Catherine Crisanti-Lassiaz Patricia Cruz Antonio A V Cruz Antonio A V Cua Daniel Cunha Armando Cunha Armando Cunha Armando Cunha S Armando Cunha S Armando Cunningham Emmett Curi Andre Czaplicka Ewa Lidia D. Scherman Dada Tanuj Dadeya Subhash Dahr Sam Daldal Nilgun Dali Nazife Damato E Bertil Daneshmand Eslami Amir Reza Das Sumita Das Taraprasad Das Taraprasad Das Taraprasad Daskalopoulos George Davey P. Michael Davey P. Michael David Larry Davis Garry
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 193
OP9-09 OP4-05 PO3-24-09 P8-4 PO2-15-02 OP2-10 PO3-24-04 OP2-07 OP11-04 PO3-19-06 PO1-01-03 P18-5 PO2-13-18 P10-5 PO2-10-07 PO2-23-21 PO3-24-11 OP5-03 OP1-02 P5-2 RF2-11 OP8-02 PO3-24-02 P5-2 OP4-03 PO3-18-01 PO3-16-02 P22-6 OP10-06 P7-5 PO3-16-03 PO1-03-07 PO1-03-08 PO2-27-02 PO1-03-10 PO3-21-12 PO3-29-01 PO1-01-07 OP6-07 P5-7 OP1-03 P13-5 S8-5 P17-3 P19-1 P19-7 P5-4 PO3-17-03 PO3-17-04 PO3-17-05 PO3-17-03 PO3-17-04 OP7-01 PO1-03-17 PO2-13-16 P17-7 PO1-02-01 PO3-24-01 PO2-23-08 PO3-21-24 PO2-11-07 P7-5 PO2-10-06 PO1-03-01 OP11-01 RF1-7 PO2-10-01 RF2-7 P2-2 P21-4 OP4-05 PO3-19-02
Abstract Book De Boer H Joke OP7-10 De Boer H. Jok OP2-05 De Dominicis Chiara PO3-21-03 De Groot-Mijnes D.F. Jolanda OP7-10 De Groot-Mijnes D.F. Jolanda OP7-07 De Groot-Mijnes Jolanda OP7-11 De Kozac Yvonne OP1-09 De Kozak Yvonne P17-3 De Kozak Yvonne P17-4 De Kozak Yvonne PO3-17-08 De Kozak Yvonne P17-5 De Monchy Ivan OP5-06 De Monchy Ivan PO2-11-04 De Saint Sardos Alexandre PO2-15-01 De Smet D Marc PO2-30-06 De Smet Marc S1-6 De Smet Marc D. P10-6 De Smet Marc D. P11A-2 De Smet Marc D. S7-1 De Smet Marc D. P23-4 De Smet Marc D. P24P25-6 De Visser Lenneke OP7-10 Debré P P5-2 Decaux Guy PO3-21-25 Dedova Julia PO2-13-04 Del Amo Victoria PO2-23-12 Delair Emmanuelle OP11-08 De-La-Torre Alejandra OP7-03 De-La-Torre Alejandra RF2-14 De-La-Torre Alejandra OP11-03 De-La-Torre Alejandra PO2-23-04 De-La-Torre Alejandra PO2-23-05 De-La-Torre Alejandra PO2-23-06 Delcampe Agnès PO2-13-13 Delgado De Souza Ana Catarina PO2-11-09 Dell’Omo Roberto PO1-03-17 Delporte Christine PO1-05-08 Delyfer Marie-Noelle PO2-15-04 Denisova Ekaterina PO1-01-05 Denisova Ekaterina Valerievna PO1-01-04 Derzko-Dzulynsky Larissa A PO2-23-13 Deterre P P5-2 Deuter Christoph OP4-08 Deuter Christoph PO1-04-01 Diaz-Llopis Manuel PO2-23-12 Diaz-Llopis Manuel PO3-17-06 Diaz-Llopis Manuel PO3-24-06 Diaz-Llopis Manuel PO3-24-07 Diaz-Llopis Manuel PO2-15-06 Diaz-Llopis Manuel PO2-10-05 Díaz-Llopis Manuel PO2-23-29 Diaz-Llopis Manuel N PO2-15-09 Dickerson Jaime OP10-08 Diedrichs-Möhring Maria PO1-05-09 Dimassi Raafa PO2-13-14 Dimassi Raafa PO2-13-15 Dimassi Raafa PO2-23-16 Do Diana OP4-07 Doan Serge PO2-13-07 Dogra Mangat RF2-10 Dogra Mangat OP8-10 Donadi A Eduardo P19-1 Dongsub Lee PO3-19-07 Dorronzoro Emilio PO2-23-26 Dotrelova Dagmar PO2-13-06 Doyle Aoife P17-5 Doyle Aoife PO3-17-08 Doyle M Trudy P6-3 Drake Rodriguez-Casanova Pilar RF2-21 Dreifuss Sylvain OP2-10 Drouet Mireille OP5-03 Drozdova Elena PO1-02-06
Drozdova Elena A. Du Zieyang Dua Harminder S. Dua Harminder S. Ducos Ghislaine Ducos Ghislaine Ducos Ghislaine Ducos Ghislaine Ducos Ghylaine Dumarey Nicolas Dupas Bénédicte Dupas Bénédicte Ebran Jean Marc Ebran Jean-Marc Edelson Catherine Edwar Lukman Eichenberger C D Gustavo El Aini Najoua El Khashab Tarek El Matri Leila El Matri Leila Eldem Bora Eliafoeillet Sylvie El-Khashab Tarek Emre Sinan Enzmann Marie-Sophie Eperon Simone Erdo?an Ceren Errera Marie-Hélène Esin Kirikkaya Evereklioglu Cem Evereklioglu Cem Fabiani Claudia Fahy Colm Falcone Giulia Falcone Giulia Faraco A G André Farah E Michel Farah E Michel Farah E Michel, Farber D Marilyn Fardeau Christine Fardeau Christine Fardeau Christine Fardeau Christine Fardeau Christine Fardeau Christine Fardeau Christine Fardeau Christine Fardeau Christine Fardeau Christine Fardeau Christine Faridpooya K. Faridpooya Koorosh Faridpooya Koorosh Farooqui Saadia Fatal Elias Fattah Dilniya Fattal Elias Fattal Elias Favard Catherine Feijoo Bernando Feist Oliver Fernandez-Munoz Marta Fernandez-Munoz Marta Ferrer Consuelo Ferrer Consuelo Ferroukhi T Fessi Hatem Fessi Hatem Feumi C Feumi Charles
PO1-01-06 OP1-02 P13-2 S8-4 RF2-1 PO1-22-05 PO3-20-06 PO1-22-10 PO3-21-27 PO3-21-25 PO1-03-16 PO2-11-04 PO3-24-11 PO2-10-07 RF2-8 PO3-21-21 P19-7 PO2-23-17 PO2-10-03 PO1-03-11 PO1-04-08 RF1-2 S3-7 PO3-21-08 PO3-21-24 P1-2 OP10-03 RF1-2 PO3-20-07 RF2-18 PO1-04-05 PO1-04-05 OP2-11 PO3-19-05 RF1-13 OP5-07 PO3-17-03 RF1-20 OP6-04 OP8-11 PO3-26-04 OP8-07 OP10-04 PO1-22-05 PO3-21-17 OP6-02 OP9-09 PO1-03-16 PO1-22-02 PO3-20-06 PO3-21-09 PO1-22-10 RF2-3 RF2-2 PO2-30-06 PO2-13-17 P17-4 P9-2 P17-5 PO3-17-08 RF2-8 PO2-13-11 PO3-24-03 PO3-18-07 PO3-19-11 PO1-03-14 PO2-13-11 P5-2 RF1-19 PO3-17-07 P5-2 OP4-03
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Fialho L Silvia Fialho L Silvia Fialho Silvia L Figueiredo R P Ana Filipec Martin Fisson Sylvain Fleury Jacques Fleury Jacques Flindri Vasiliki Flindri Vasiliki Forrester V John Forrester V John Forrester V John Fort Patrice Fortuna Cinzia Fortunato Michele Foster C. Stephen Foster C. Stephen Foster C. Stephen Foster C. Stephen Foster C. Stephen Foster C. Stephen Foster Stephen C Foster Stephen C. Fraser-Bell Samantha Freeman M. Willard Freitas Geovani Alisson Fremeaux Bacchi Veronique Fridman Catherine Friedlin Julie Friling Ronit Fu D Arthur Fukuda Masahide Fukushima Atsuki Fukushima Atsuki Gabison Eric Gabison Eric E Gallagher J Micheal Gallagher Michael Gandolphe C Ganser Gerd Gao Fei Garcia A Carlos Garcia Carlos Garcia Carlos Garcia Carlos Garcia Carlos Alexandre Garcia Carlos Alexandre Garcia Claudia Me Ana Garcia Claudia Me Ana Garcia Claudia Me Ana Garcia Claudia Me Ana Garcia Claudia Me Ana Garcia Filho Alexandre Carlos Garcia Filho Alexandre Carlos Garcia Filho Alexandre Carlos Garcia Filho Alexandre Carlos Garcia Filho Alexandre Carlos Garcia Olga García-Delpech Salvador Garcia-Delpech Salvador Garcia-Delpech Salvador Garcia-Delpech Salvador Garcia-Delpech Salvador Garcia-Delpech Salvador Garcia-Pous Maria Garcia-Pous Maria Garcia-Pous Maria Gardner Thomas W. Gardner W. Thomas Garg Satpal Garg Satpal
PO3-17-04 PO3-17-05 PO3-17-01 P19-7 PO2-13-06 OP1-09 OP2-01 RF2-17 RF2-7 PO3-26-10 PO1-02-05 PO1-22-04 PO3-26-07 PO2-12-02 PO3-21-13 PO1-01-01 P1-5 S2-2 PO1-01-10 PO1-01-11 PO2-15-11 PO3-24-09 OP4-07 PO2-13-17 PO2-23-20 PO2-12-02 OP8-03 OP4-01 OP1-09 P1-2 OP2-03 OP7-01 PO3-21-20 P9-1 PO2-23-24 PO2-13-07 P13-3 PO1-01-11 PO2-13-17 P17-6 PO3-24-08 PO1-03-13 RF2-16 PO1-22-06 PO1-22-07 PO2-11-08 OP8-03 OP8-04 OP8-04 OP8-03 PO1-22-06 PO1-22-07 PO2-11-08 OP8-03 OP8-04 PO1-22-06 PO1-22-07 PO2-11-08 PO1-04-04 PO2-23-29 PO2-10-05 PO2-15-09 PO3-17-06 PO3-24-06 PO3-24-07 PO2-23-29 PO2-15-09 PO2-23-12 P12-1 PO2-12-02 OP9-01 PO1-02-02
Abstract Book Garg Satpal Garg Satpal Garg Satpal Garg Satpaul Garg Satpaul Gargouri Salma Gargouri Salma Garweg G Justus Garweg Justus G. Garweg Justus G. Garweg Justus G. Gautier David Gavala Caterina Gavala Caterina Gavala Caterina Gavala Caterina Gavala Caterina Georgantis Hlias Georgantis Hlias Gerstenblith Adam Gharai Sujit Gharai Sujit Gharai Sujit Gharai Sujit Ghrissi Rim Ghrissi Rim Ghrissi Rim Gilad Litvin Giovannini Alfonso Giovannini Alfonso Giovannini Alfonso Giraudet Sylvia Gisèle Soubrane Globocnik Petrovic Mojca Goda Chiho Goepogui André Goes Frank M Goh Y Kong Goldberg A Robert Goldhardt Raquel Goldschmidt P Goldschmidt P Goldschmidt Pablo Goldstein A Debra Goldstein A. Debra Goldstein Debra Goldstein Michaela Goldstein Michaella Gomes Dos Santos Ana Gomes Dos Santos Ana L. Gomes Henrique B Alexandre Gomes Henrique B Alexandre Gomes Henrique B Alexandre Gomez-Marin E Jorge Gomez-Marin E Jorge Gomez-Marin E Jorge Gomez-Marin E Jorge Gomez-Marin Jorge Gomez-Marin Jorge Gonzalez Guijarro Juan Jacobo Goodwin A Kelley Gorrono Echevarria B Marina Gorrono Echevarria B Marina Gorroño Marina Gorrono-Echebarria B. Marina Goto Hiroshi Goto Hiroshi Goto Hiroshi Gotoh Yoko Graham E. M. Grajewski Rafael S Grange Jean-Daniel
RF1-17 PO3-21-02 PO3-26-01 RF2-23 PO2-15-07 PO2-23-16 PO2-13-15 OP2-01 OP2-08 RF2-12 RF2-20 PO2-10-07 PO1-03-03 PO1-03-04 PO1-03-06 PO2-13-08 PO2-23-33 PO1-03-06 PO2-23-33 OP4-07 OP9-01 PO1-02-02 PO3-21-02 PO3-26-01 RF2-19 OP2-06 PO2-23-16 OP9-04 OP4-06 PO1-22-08 PO3-21-13 PO2-23-21 P22-6 PO2-23-25 OP11-06 OP5-10 OP5-04 OP9-10 PO3-19-03 PO3-16-02 PO3-20-07 PO2-13-18 OP5-10 PO3-26-04 OP3-07 P1-2 RF2-22 PO3-19-03 PO3-17-08 P17-5 OP8-03 OP8-04 PO2-11-08 RF2-14 OP11-03 PO2-23-04 PO2-23-06 OP7-03 PO2-23-05 PO1-22-03 P6-3 PO1-02-04 PO2-11-06 PO2-23-23 OP9-08 PO2-30-01 PO3-26-03 PO3-17-02 OP1-01 PO2-23-09 P5-5 RF1-9
Grange Jean-Daniel Grange Jean-Daniel Grange Jean-Daniel Graziani Giovanna Grenet Typhaine Grigg Michael Grigg Michel Guenaydin Ilhan Gueudry Julie Gueudry Julie Gueudry Julie Guex-Crosier Y. Guex-Crosier Yan Guillaume-Czitrom Severine Güliter Sefa Gullapalli Vamsi Güllü Reyhan Gungor Sirel G Gungor Sirel G. Gupta Amod Gupta Amod Gupta Amod Gupta Amod Gupta Amod Gupta Amod Gupta Amod Gupta Vishali Gupta Vishali Gupta Vishali Gupta Vishali Gupta Vishali Gupta Vishali Gupta Vishali Gurelik Gokhan Gurny Robert Gutierrez Ortiz Consuelo Guymer H Robyn Haahtela Tari Hachicha Walid Hachicha Walid Haddad Antonio Haddad Lamine Haeran Chang Halberstadt Markus Hardy Pierre Hartani Dahbia Hasanreisoglu Berati Hashida Noriyasu Hasnaoui Wafa Hasnaoui Wafa Hasnaoui Wafa Hatou Shin Hayday C Adrain Heckenlively John R. Heiligenhaus Arnd Heiligenhaus Arnd Heinz Carsten Heinz Carsten Heissigerova Jarmila Herbort Carl P. Herbort Carl P. Herbort Carl P. Heringer C. Gustavo Hernandez L Maria Hernandez-Garfella Marisa Hernandez-Garfella Marisa Hernandez-Garfella Marisa Hmidi Kamel Hmidi Kamel Hmidi Kamel Hmidi Kamel Ho Su Ling
RF2-17 OP7-06 PO3-29-01 OP3-02 PO3-21-17 OP8-06 OP7-09 OP4-08 PO1-04-12 PO2-13-13 PO3-20-06 OP10-02 OP10-03 OP3-08 PO3-18-06 PO3-24-04 PO3-18-05 PO1-04-11 PO3-26-08 RF2-5 OP7-02 OP8-10 OP11-02 PO2-23-32 RF2-10 PO3-28-01 RF2-10 OP7-02 PO2-23-32 RF2-5 OP8-10 OP11-02 PO3-28-01 PO3-20-08 OP10-03 RF2-21 P8-2 RF1-14 RF1-19 PO3-17-07 PO3-17-05 PO2-23-30 PO3-19-07 RF2-12 PO1-05-05 PO1-04-09 PO3-20-08 PO1-05-03 PO2-13-15 PO3-19-10 PO3-28-05 PO2-13-09 PO1-04-07 P12-6 PO3-24-08 OP2-02 OP2-02 PO3-24-08 PO2-23-03 P7-2 P11B-5 OP8-12 PO1-03-17 PO2-15-06 PO2-23-12 PO3-17-06 PO3-24-07 PO2-23-19 PO3-19-10 PO2-13-15 PO3-16-05 PO3-26-07
Hoang Xuan Than Hoang-Xuan Than Hochwarter Anelia Hoffmann Christiane Holder Graham Holland Gary Hong Lu Hong Lu Hongyan Zhou Hongyan Zhou Hori Junko Hori Sadao Horie Shintaro Horie Shintaro Ho?al Banu Houda Belguendouz Houda Belguendouz Houssier M Houssier M. Hu Tiansheng Hubschman Jean-Pierre Huet Eric Hughes Edward Hummel Michael Iannetti Ludovico Iannetti Ludovico Ikeji Felicia Iliev E. Milko Ilya Rozenbaum Imai Hiroki Imai Hiroki Imai Hisanori Imai Reiko Ingster-Moati Isabelle Irkeç Murat Irkeç Murat Isabelle Cochereau Ishibashi Kazuki Ishibashi Tatsuro Islam Niaz Iwakura Yoichiro Iwata Daiju Jacko J Scoper V Stephen Jakob Eva Jakob Eva Jallet Ghislaine Jallet Gishlaine Janier Marc Janssens Jean-Paul Janssens Sarah Januário N José Jap Aliza Jap Hee Eng Aliz Jeanny Jc Jeguirim Houyem Jelliti Bechir Jelliti Bechir Jelliti Bechir Jelliti Béchir Jenickova Dagmar Jenzeri Salah Jenzeri Salah Jenzeri Salah Jenzeri Salah Jenzeri Salah Jimenez Clara Jimenez Jaime Jl. Schmit Job A Raly Johnson N Robert Johnston Susan Jones Jeffrey
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PO2-13-13 PO2-13-07 PO3-21-06 PO1-05-09 PO3-21-26 PO3-26-06 PO2-11-05 PO3-28-02 PO1-02-03 OP3-06 OP5-14 PO3-18-02 PO2-30-02 OP8-12 PO3-19-09 PO1-04-09 PO1-05-07 P5-2 OP4-03 PO1-03-13 PO2-15-04 P13-3 OP9-02 P7-5 RF2-11 PO2-30-04 PO1-02-08 RF2-12 PO2-11-12 PO1-05-01 PO3-20-01 PO3-21-20 PO3-20-01 PO2-23-30 RF1-2 RF1-12 OP5-10 PO3-21-20 PO1-04-13 RF2-13 P5-4 OP3-03 OP5-08 PO3-26-11 OP7-05 PO2-10-07 PO2-23-21 RF1-9 OP7-04 PO1-05-08 RF1-1 PO2-10-08 OP2-09 P5-2 PO2-13-14 PO2-23-17 PO3-28-06 PO1-04-10 PO2-23-18 PO2-23-03 PO1-04-10 PO2-23-14 PO2-13-12 PO2-23-18 PO3-19-10 PO1-01-03 P27-4 PO2-10-09 PO3-21-08 OP7-01 PO3-19-05 PO3-26-06
Abstract Book Jonet L Jorge Rodrigo Jorge Rodrigo Jorge Rodrigo Jorge Rodrigo Joseph Joveeta Jovanovic D Milenko Jovanovic Svetlana Julian Lilian Julian Lilian Julian Lilian Jumper Michael J Just Eduardo Just Eduardo Kaczmarski Maciej Kadayifcilar Sibel Kadayifcilar Sibel Kahloun Rim Kai Sanjay Kaines Andrew Kalogeropoulos Chris Kalogeropoulos Chris Kamaya Shuhei Kamlesh Kammoun Skander Kammoun Skander Kampouridis Stelianos Kangave Dustan Kangave Dustan Kanji Takahashi Kaplan Henry J Kaplan Henry J Karaliute Zydrune Kari Marjatta Kari Marjatta Kari Osmo Kari Osmo Kari Osmo Karıncao?lu Yelda Karren Landon Kasapcopur Ozgur Katargina Anatolyevn Ludmila Katargina Anatolyevn Ludmila Kavuncu Sevim Kavuncu Sevim Kawaguchi Tatsushi Kayako Matsuyama Keikina Lyazzat Keino Hiroshi Keino Hiroshi Kempen John H. Kerkhoff T Frank Kertes J Peter Kesen Muge R. Kezuka Takeshi Kezuka Takeshi Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef
P5-2 PO2-10-04 PO3-17-01 PO3-17-04 PO3-17-05 PO2-10-01 PO3-21-15 PO3-21-15 PO1-03-07 PO1-03-08 PO2-27-02 OP7-01 OP6-03 PO2-11-09 PO2-13-05 RF1-2 RF1-12 PO2-23-18 PO1-02-01 PO2-30-05 RF2-7 PO3-26-10 OP1-01 PO3-24-01 PO2-23-19 PO3-16-05 PO3-21-10 OP8-08 OP6-01 PO3-20-04 OP4-10 P21-1 PO2-23-07 OP5-09 RF1-18 RF1-18 RF1-14 OP5-09 PO3-21-24 OP1-08 OP10-05 PO1-01-04 PO1-01-04 PO2-23-15 PO3-26-09 OP8-12 PO3-20-04 PO1-03-12 OP8-09 PO3-17-02 P6-5 OP7-10 PO2-23-13 OP3-07 PO2-30-01 PO3-26-03 PO2-23-14 P4-4 OP2-06 RF2-19 P21-5 PO1-02-07 PO1-04-10 PO2-09-03 PO2-13-12 PO2-13-14 PO2-13-15 PO2-13-18 PO2-23-16 PO2-23-17 PO2-23-18 PO2-23-19
Khairallah Moncef Khairallah Moncef Khairallah Moncef Khairallah Moncef Khemakhem Riadh Khoroshikh I Yulia Kido Sayaka Kidron Dvorah Kidron Dvorah Kikuchi Takanobu Kikuchi Takanobu Kim Myoung Joon Kim Yoon Hee Kimball R. Scot Kimoto Takashi Kimura Motoki Kiriakopoulos Nikos Kiriakopoulos Nikos Kiriakopoulos Nikos Kısa Üçler Kitaichi Nobuyoshi Kitaichi Nobuyoshi Kitaichi Nobuyoshi Kitamura Mizuki Kitamura Mizuki Koch Jörg Koch Philippe Koci?cki Jaros?aw Kodjikian Laurent Kodjikian Laurent Kodjikian Laurent Kodjikian Laurent Kodjikian Laurent Kodjikian Laurent Kodjikian Laurent Kodjikian Laurent Kodjikian Laurent Koetter Ina Koetter Ina Koh Jae Woong Koklu Gultekin Koklu Gultekin Kondeatis E. Kondo Misuzu Kone-Paut Isabelle Konstantopoulou Claire Konstantopoulou Kallirroi Korobelnik Jean-Francois Köse Süheyla Kostakou Agori Kotaniemi Kaisu Kotsidas Ioannis Kotsidas Ioannis Koufakis Dimitrios Kouprianoff Sabine Kovalczuk L Kovalevskaya A. Maria Kovalevskaya Maria Kramer Michal Kraut Aleksandra Kraut Aleksandra Kriauciuniene Loresa Krivosheina I Olga Küçük Özlem Kumar Chandra Shekhar Kumar Shekhar Chandra Kurt Rengin Kurt Rengin A. Kyriakopoulos Nikos L. Bossy-Nobs Labbé Antoine Labbe Antoine
PO3-16-05 PO3-19-10 PO3-28-05 PO3-28-06 PO2-23-17 PO2-08-02 PO2-30-02 OP9-04 OP9-05 PO1-05-01 PO3-20-01 PO1-01-02 PO3-16-04 PO2-12-02 PO2-23-34 PO2-23-34 PO1-03-04 PO1-03-06 PO2-23-33 PO1-04-03 OP1-04 OP3-03 OP11-06 OP1-04 OP11-06 OP2-02 PO3-21-10 PO2-13-16 OP2-01 RF2-17 OP7-06 RF1-9 RF1-19 P10-4 RF2-12 PO3-17-07 PO3-29-01 PO1-04-01 OP4-08 PO1-05-02 PO2-23-15 PO3-26-09 PO2-23-09 PO2-23-24 OP3-08 PO3-16-06 RF2-9 PO2-15-04 RF1-3 PO1-02-05 P1-4 PO1-03-06 PO2-23-33 RF2-9 PO3-21-16 P17-7 PO2-13-04 PO2-13-02 OP2-03 PO2-23-25 PO3-29-02 PO3-21-07 PO2-08-02 PO3-19-09 RF1-17 PO2-15-07 PO2-11-13 OP5-05 PO1-03-03 OP10-02 PO2-13-07 OP6-06
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Labbe Antoine Labbé Antoine Labetoulle Marc Labetoulle Marc Labetoulle Marc Lahmar-Belguendouz Karima Lahmar-Belguendouz Karima Lai Timothy Y Lajavardi Laure Lam S C Dennis Lam Sc Dennis Lam Sc Dennis Lam Wai-Ching Lam Wai-Ching Lambert Gregory Lamirel Cedric Lamirel Cédric Landry Theresa Langner-Wegscheider Beate J Larkin Frank Laroche J-M Latkany A. Paul Lattanzio A Frank Lattanzio A Frank Lau Winnie Wai Ying Laura Callegarini Lavalette S Lavin M Mike Le Guellec Chantal Le Hoang Phuc Le Hoang Phuc Le Hoang Phuc Le Hoang Phuc Le Prince Anna Maria Le Prince Annamaria Le Scanff Julie Le Thi Huong D Lee C.L Lee Cheryl Lee Cheryl Lee Kevin Lee Miyeon Lee Miyeon Lee Mun-Wai Lee Tl Lefebvre Pierre Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Lehoang Phuc Leibovitch Igal Leibovitch Igal Leite F Helena Lemarié Carole Lemelle Irène Lemy Anne Leon A. Leon A. Leon A. Leonardi Andrea Leonardi Andrea Leonardi Andrea Letien Valérie
PO2-11-04 P13-4 OP1-03 PO2-11-04 OP5-06 PO1-05-07 PO1-04-09 PO3-28-04 P17-4 PO3-28-04 PO1-03-15 PO1-03-02 PO3-21-05 PO2-15-08 S3-6 PO2-23-21 PO3-24-11 OP10-08 PO2-30-06 P9-2 PO2-13-13 PO2-11-12 OP5-08 RF2-24 PO3-21-18 PO2-09-02 P5-2 PO3-21-08 PO2-10-11 PO3-20-06 PO1-04-12 PO1-03-16 PO3-21-27 PO2-23-28 PO3-18-03 PO3-18-01 OP10-04 RF2-15 OP6-02 PO3-21-09 PO2-23-13 RF1-19 PO3-17-07 PO2-11-11 PO3-21-18 PO3-21-25 OP1-09 S5-2 OP8-07 OP9-09 PO1-01-09 PO3-21-17 PO3-21-09 OP6-02 RF2-1 OP10-04 PO1-22-02 PO1-22-05 PO1-22-10 PO3-19-02 PO3-19-03 PO3-17-03 PO2-10-07 PO1-01-07 PO3-21-25 PO2-08-01 PO2-12-01 PO2-27-01 OP5-01 S3-4 P9-2 PO1-22-05
Abstract Book Leung Ks Christophe Leveziel Nicolas Leveziel Nicolas Levidiotou Stamatina Levinson Ralph Levy Jaime Li Wang Li Wang Li Wang Li Wang Li Wei Heng Libert Jacques Lichter Paul R. Lie Schlickeiser Stephan Q Liesenfeld Oliver Lim L Lyndell Limaiem Rym Limin Liu Lin Phoebe Lin Xing Liu Yunxia Liverani Marco Liverani Marco Liversidge Janet Liversidge Janet Loba Adjon Lopez-Castillo A Christian Lopez-Castillo A Cristian Lopez-Castillo Cristian Lora Fabiana Losiewicz K. Mandy Lourdes Arellanes Lowenstein Anat Luca Cappuccini Luca Cimino Luger Dror Maalouf Toufic Maalouf Toufic Määttä Marko Macdonell Rebecca Machado Carellos V Ericka Maciel Z Lea Mackensen Friederike Mackensen Friederike Mackensen Friederike Mackensen Friederike Mackensen Friederike Maggi R. Mahon Gerald Maillet Séverine Malamou-Mitsi D Vasiliki Maldonado Miguel J. Malec Jiri Mandal Subrata Manivanan Ayyakkannu Manivannan Ayyakkannu Mannucci Lorenzo Mannucci Lorenzo Manoni Mara Mantilla D Ruben Manzouri Bita Marechal Cécile Mariette Xavier Mariotti Cesare Mariotti Cesare Mariotti Cesare Martello Claudia Martin R. Tammy Martin R. Tammy Martin Tammy M Martinez Cartier D Mauricio Martin-Villa M. José
PO1-03-02 OP4-01 OP4-02 PO3-26-10 OP1-02 RF1-21 OP5-13 PO3-20-03 PO3-28-03 PO1-02-03 PO3-21-19 PO3-21-10 P12-6 OP5-12 OP8-06 PO2-11-07 PO1-04-08 OP5-13 PO3-26-04 OP3-05 OP3-01 OP2-04 RF2-11 P5-7 OP6-07 PO2-23-19 RF2-14 OP7-03 PO2-23-04 OP7-03 PO2-12-02 P22-1 RF2-22 OP11-07 OP11-07 P5-4 PO1-01-07 PO1-01-08 OP5-09 PO2-15-11 RF1-1 P19-1 PO2-11-07 P1-2 OP7-05 PO3-20-02 PO3-26-11 PO1-01-01 PO2-11-10 OP1-03 PO3-26-10 P3-1 PO2-13-06 RF2-23 P5-7 OP6-07 RF1-13 OP5-07 PO1-22-08 RF2-14 P9-2 PO3-24-11 OP5-06 OP4-06 PO1-22-08 PO3-21-13 PO2-23-31 P2-2 P21-4 P6-3 PO2-27-02 OP9-08
Maruyama Koich Maruyama Koichi Mascaro Fabrizio Massaoutis Panos Mathai Annie Mathur Mukul Matsumura Miyo Matsushita Eriko Matusmoto Chota Mauget-Faysse Martine Maurin Max Max Regina Max Regina Maychuk Dmitriy Mazit Cherif Mazit Cheriff Mccarty A Catherine Mcdonald Richard H Mckee G Medder-Ouertani A Mehta Falguni Menicacci Felice Menolascina Luisa Menolascina Luisa Mercanti Lucia Merdassi Ahlem Merle-Béral Hélène Mesa Juan Carlos Messaoud Riad Messaoud Riadh Messaoud Riadh Messaoud Riadh Messaoud Riadh Messaoud Riadh Messaoud Riadh Messaoudene Djamel Messaoudene Djamel Metzner Silvia Meunier Isabelle Meunier Isabelle Meunier Isabelle Mezquida Gloria Mezquida Gloria Mghaeith Fatma Michels Hartmut Milazzo S. Miller Joan W Minari Miriam Mirza Ertugrul Galip Miserocchi Elisabetta Miserocchi Elisabetta Missotten Tom Mitchell Bradley Miyazaki Akiko Miyo Matsumura Mnasri Heni Mnasri Heni Mocan Cem Mochizuki Hiroshi Mochizuki Manabu Mochizuki Manabu Mochizuki Manabu Modorati Giulio Modorati Giulio Mohan Ravindra Monnet Dominique Monnet Dominique Monnet Dominique Montan Per Montero A Javier Montero Javier Montero Javier
PO2-30-03 PO3-21-04 P19-1 PO3-21-26 PO2-10-02 PO3-19-01 PO2-23-34 PO2-23-24 PO2-30-03 P22-6 OP9-07 PO3-20-02 PO3-26-11 PO2-09-01 PO2-23-21 PO3-24-11 P8-2 OP7-01 PO3-19-05 PO2-13-18 PO1-03-01 RF2-25 P21-7 PO3-26-02 OP4-06 PO1-03-11 OP6-02 PO1-04-04 PO2-23-16 RF2-19 OP2-06 PO2-23-14 PO2-23-17 PO3-28-05 PO3-28-06 PO1-04-09 PO1-05-07 RF1-5 RF2-8 PO2-23-28 PO3-18-03 PO1-03-14 PO2-13-11 PO1-03-11 PO3-24-08 PO2-10-09 P8-7 PO2-10-04 PO1-04-05 OP8-02 PO3-24-02 OP11-05 PO1-05-04 OP3-03 PO3-20-04 OP2-06 PO2-09-03 RF1-12 PO2-13-09 P20-1 OP8-12 PO2-30-02 PO3-24-02 OP8-02 P19-6 PO2-23-30 OP1-02 OP11-08 P10-1 P22-3 PO2-09-04 PO2-10-10
Montero Javier Montero Javier Montero Javier Montero Javier Montero Javier A Moonjeong Choi Morad Yair Morange Virginie Moratal Peiró Baltasar Morekar Mayur Morekar Mayur Mori Hideki Morio Tomohiro Mosconi Paola Mosgrove Lori Motterle Laura Mouriaux Frédéric Moutray Tanya Moutray Tanya Mrugacz Malgorzata Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Muccioli Cristina Mukamel Masha Mulder M. M. Muñoz Joan Mura Frédéric Mura Marco Muraine Marc Murialdo Ugo Murthy B Kalpana Murthy Krishna R. Mwaikambo Bupe Naas Thierry Nahoko Ogata Naik Hetal Nakakuki Toshiaki Nakanishi Noriko Nakauchi Tadashi Namba Kenichi Namba Kenichi Napoli Giuseppe Nardin Alessandra Naud Marie-Christine Navea Tejerina Amparo Nbitiki F Martial Neri Piergiorgio Neri Piergiorgio Neri Piergiorgio Ness Thomas Neugebauer Mark Neumann Ron Neumann Ron Ng Anita S.Y Ng Sy Anita Nguyen Anh Minh Nguyen Dong Quan Nguyen Quan Dong Nijhavan Raje Nikos Kiriakopoulos Nishimura Tetsuya Nishino Koji
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PO3-18-07 PO3-19-11 PO2-15-06 PO3-17-06 P23-1 PO2-15-03 RF1-6 PO2-10-11 PO2-10-05 RF1-7 OP11-01 PO2-30-01 PO2-30-02 PO3-24-02 OP1-07 PO3-26-02 PO3-21-12 PO2-11-10 PO3-19-05 PO2-13-05 OP8-05 RF1-20 OP6-04 OP7-08 OP8-11 PO2-11-01 PO2-11-02 PO2-11-03 PO2-23-02 PO2-23-11 PO3-26-06 OP7-09 PO2-15-10 OP2-03 RF2-3 PO1-04-04 PO3-21-27 PO2-30-06 PO2-13-13 PO2-09-02 OP9-03 PO3-21-01 PO1-05-05 OP1-03 PO3-20-04 PO3-19-04 PO2-23-24 PO3-21-20 PO2-23-34 OP1-04 OP11-06 PO2-09-02 P17-3 P17-4 PO2-23-29 PO3-29-01 OP4-06 PO1-22-08 PO3-21-13 PO2-23-10 PO2-10-03 PO3-21-11 RF1-21 RF2-15 PO3-21-18 RF2-17 OP4-07 OP7-12 PO2-23-32 PO2-13-08 PO2-23-34 PO2-23-24
Abstract Book Niskopoulou Maria Niskopoulou Maria Nochez Yannick Nordmann Patrice Novoa J Luis Nubourgh Isabelle Nussenblatt Robert N. O. Felt-Baeyens Offret Hervé Offret Hervé Offret Hervé Ohbayashi Masaharu Ohguchi Takeshi Ohguchi Takeshi Ohguro Nobuyuki Ohguro Nobuyuki Ohguro Nobuyuki Oh-I Keiko Oh-I Keiko Ohno Shiegeaki Ohno Shigeaki Ohno Shigeaki Ohno Shigeaki Ohno Shigeaki Ohno Shigeaki Ohno-Matsui Kyoko Ohta Kouichi Ohta Kouichi Okada A Annabelle Okada Annabelle A Oktem Caglar Olson John Onaran Zafer Ono J Santa Onoe Kazunori Oréfice Fernando Ornek Kemal Örnek Kemal Orsoni Yelka Ortega-Larrocea Gabriela Ortega-Larrocea Gabriela Oshima Masamichi O’Toole Louise Otsu Yayoi Otuk Berna M. Oueghlani Evelyne Oueghlani Evelyne Oueld El Hassen Mohamed Ozdal Çakar Pınar Ozdal Pinar Özdemir Özden Ozmert Emin Özmert Emin Ozyazgan Yilmaz Padoin Christophe Pajot Christine Pajot Olivier Palermo Eliana Palomares Paula Palomares Paula Panda Anita Pang Claudine Papadopoulou Anatoli Papadopoulou Anatoli Paroli Maria Pia Pascal Furrer Pathengay Avinash Pathengay Avinash Pathengay Avinash Pathengay Avinash Pathengay Avinash Patiakas Stefanos
PO3-16-06 RF2-9 PO2-10-11 OP1-03 RF2-16 PO3-21-25 P6-2 OP10-02 OP1-03 OP5-06 PO2-11-04 P9-2 PO2-13-20 PO2-13-19 PO1-04-02 RF1-23 PO1-05-03 PO3-26-03 PO3-17-02 OP3-03 OP1-04 OP11-06 PO2-13-19 PO2-13-20 P4-7 OP8-12 PO3-20-01 PO1-05-01 RF1-23 OP8-09 PO3-26-08 PO3-26-07 PO3-18-06 P9-2 OP1-04 RF1-1 PO3-18-05 PO3-18-06 OP2-07 PO3-21-14 PO3-24-05 OP5-14 PO2-23-20 PO2-23-34 RF1-4 PO1-03-17 PO3-16-06 PO2-23-14 PO2-23-15 PO3-26-09 PO1-04-03 PO3-18-04 PO2-11-13 OP3-09 PO2-10-11 OP3-08 PO2-10-07 PO2-30-04 PO2-10-05 PO2-15-06 PO1-02-01 PO3-19-08 PO1-03-06 PO2-23-33 OP2-04 OP10-02 RF1-7 OP11-01 PO2-10-01 PO2-10-02 P10-7 PO1-03-04
Patiakas Stefanos Paula Sheila Pavese Patricia Pavesio Carlos Pavesio Carlos Pavesio Carlos Pavesio Carlos Pavesio Carlos Pavesio Carlos Pavesio E Carlos Pavesio E. Carlos Paz Moreno-Arrones Javier Paz Moreno-Arrones Javier Paz Moreno-Arrones Javier Pearce A Ian Pêcheur Charles Peepre Karan Peizeng Yang Peizeng Yang Peizeng Yang Peltonen Sirje Peng Xiaoyan Perez-Blas Mercedes Peri Simona Perinti Andrea Pesci Francesca Romana Petropoulos Ioannis Petrushkin Harry Peyman Gholam Peyron François Peyron François Pézard A Phuc Lehoang Picard E Piette Jean Charles Piette Jean Charles Piette Jean-Charles Pirraglia Maria Pia Pirraglia Maria Pia Pisal R. Pisella Pierre-Jean Pivetti Pezzi Paola Pivetti-Pezzi Paola Pivetti-Pezzi Paola Planck R. Stephen Planck R. Stephen Plant T Gordon Pleyer Uwe Pleyer Uwe Pleyer Uwe Pleyer Uwe Pleyer Uwe Pleyer Uwe Pop Mihai Pop-Fanea Laura Popovic Petra Prabhakaran Venkatesh Prazeres Sandra Prazeres Sandra Prieur Anne-Marie Prieur Anne-Marie Primrose Profazio Vincenzo Puchko Snezhanna Puech Cindy Pyatesky Dimitry Qianli Meng Qianli Meng Quartier Pierre Queiroz De Andrade M Gláucia Quek Desmond Quijano Claudia
PO2-13-08 P19-7 OP9-07 PO2-30-05 PO3-16-06 RF2-9 RF2-13 PO2-23-20 PO3-21-26 PO1-02-08 PO1-03-17 RF2-21 PO1-02-04 PO2-11-06 PO2-23-27 PO1-01-08 PO3-19-01 OP3-05 OP3-06 PO1-02-03 OP5-09 OP3-01 OP9-08 PO2-09-02 RF2-25 PO2-30-04 OP10-03 OP9-02 PO3-16-02 OP2-01 OP2-08 P5-2 OP2-10 P5-2 PO3-21-17 PO1-04-12 OP9-09 OP2-11 PO2-30-04 PO3-19-01 PO2-10-11 OP2-04 OP2-11 RF2-11 P2-2 P21-4 OP9-02 OP5-12 OP8-06 PO3-24-03 RF1-5 P14-3 PO2-23-07 PO2-13-18 P5-7 PO3-29-02 PO3-19-02 PO1-01-09 P1-2 P1-1 PO1-01-09 PO3-19-05 OP10-06 PO1-03-12 OP9-07 P1-2 PO1-02-03 OP3-05 PO1-01-09 RF1-1 PO1-22-01 RF2-16
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 198
Quinones Karina Quinones Karina Quinones Karina Quinones Karina R. Gurny R.Murthy Krishna Ract Madoux Guillaume Rajagopalan Nirmala Rama Paolo Rama Paolo Rane Tej Rao Narsing Rao Narsing Rao Veena Raoul W Raoul W. Read Russell W. Read Russell W. Reed George Reitamo Sakari Renoux Christel Rhéaume Marc-André Ribeiro-Filho Elias Richard Florence Richardson J Andrea Rihova Eva Rios S Lilia Rios-Cadavid C Angela Rios-Cadavid C Angela Ritter T Ritter Thomas Ritter Thomas Rizzo Luis Rizzo Luiz Rizzo V Luis Rizzo V Luis Robert Pierre-Yves Robert Py Robman D Luba Rodéro M Rodrigues L V Maria Rodriguez E Alejandra Rodriguez Laura Rodriguez-Perez Noellia Romanet Jean-Paul Romanet Jean-Paul Rosenbaum James Rosenbaum James T Rosenbaum James T Rosenbaum T James Rosenbaum T James Rosenbaum T. James Rosenzweig Holly Rosenzweig Holly Rothova Aniki Rothova Aniki Rothova Aniki Rougier Marie-Benedicte Rueda C Juan Ruiz-Moreno Jose M Ruiz-Moreno M Jose Ruiz-Moreno M Jose Ruiz-Moreno M Jose Ruiz-Moreno M Jose Ruokonen Peter Rutzen Allan R. Rym Limaiem S. Eperon Saari K. Matti Saari K. Matti Saari K. Matti Sach Josef
PO1-01-10 PO1-01-11 PO2-15-11 PO3-24-09 OP10-02 OP9-03 PO3-29-01 OP9-03 OP8-02 PO3-24-02 PO2-23-27 OP1-11 P7-1 PO1-01-10 P5-2 OP4-03 P6-8 P15-2 P1-2 RF1-18 PO3-18-01 PO2-15-01 PO3-17-05 OP4-02 P8-2 PO2-23-03 OP8-05 OP11-03 PO2-23-06 P14-3 P14-4 OP5-12 PO2-23-11 OP7-08 OP7-09 OP8-05 OP5-03 PO2-13-18 P8-2 P5-2 P19-1 PO2-13-11 PO3-21-03 OP9-08 OP9-07 PO3-21-16 OP4-05 P2-2 P21-4 P6-3 PO2-11-07 P18-1 P2-2 P21-4 OP7-07 OP2-05 OP7-10 PO2-15-04 RF2-14 P22-3 PO3-18-07 PO2-10-10 P23-1 PO2-09-04 RF1-5 P3-5 PO1-03-11 OP10-02 RF1-14 OP5-09 RF1-18 PO2-23-03
Abstract Book Sachdev Nishant Sachdev Nishant Sachdeva Virender Saeed P. Saeed Peerooz Sahel J-A Saishin Yoshitsugu Sakaguchi Shimon Sakai Jun-Ichi Sakai Jun-Ichi Saliba B Juliana Salom Alonso David Salom David Salom David Salom David Salom David Salom David Salom David Salom David N Salvarani Carlo Sanchez-Poton A. Sanchis M Eugenia Sanchis M Eugenia Sanchis M Eugenia Sano Kenji Saraswathy Sindhu Sarfati Eric Sarfati Eric Sartori Antonio Satish B Sattin Andrea Sawitzki Scherman D Scherrer Janine Scherrer N. Janine Schlaen A Ariel Schlaen Ariel A Schmidt Nadine Schmit Isabelle Schultz A Kara Schultze Döbold Claudia Scoper V Stephen Sébag Mikaël Secchi Antonio Segundo Souza Paulo Segundo Souza Paulo Segundo Souza Paulo Selva Dinesh Selva Dinesh Sen H. Nida Sen Seema Sennlaub F Sennlaub F. Serif Nigar Setiobudi Cecilia Seve Pascal Seve Pascal Sève Pascal Seve Pascal Seyahi Emire Shafi Seema Shao Hui Sharma K S Sharma K S Sharma Savitri Sharma Savitri Sharma Savitri Sharma Savitri Sharp Peter Shen Defen Sheppard John D Sheppard John D
PO3-28-01 OP11-02 PO2-10-01 RF2-3 RF2-2 PO3-20-07 PO1-04-02 OP5-14 PO2-30-01 PO3-26-03 PO3-17-03 PO2-23-29 PO2-10-05 PO2-15-06 PO2-15-09 PO3-17-06 PO3-24-06 PO3-24-07 PO2-23-12 OP11-04 S6-2 PO2-10-10 PO3-18-07 PO2-09-04 PO3-20-01 OP1-11 PO2-23-28 PO3-18-03 PO3-19-06 OP9-03 P21-7 OP5-12 P17-6 RF2-20 RF2-12 PO1-03-10 PO3-16-03 PO3-24-03 PO3-21-27 PO3-26-04 OP4-09 RF2-24 PO2-15-01 P21-7 OP8-04 PO1-22-06 PO2-11-08 PO3-19-02 PO3-19-03 P1-2 PO1-02-01 P5-2 OP4-03 PO3-20-08 PO2-11-07 RF1-9 PO3-18-01 RF2-17 OP7-06 OP3-09 PO1-04-07 OP4-10 PO3-26-01 OP9-01 OP11-01 RF1-7 PO2-10-01 PO2-10-02 OP6-07 PO3-19-06 PO2-15-05 OP5-08
Sheppard John D. Shimakawa Machiko Shimizu Norio Shimomura Yoshikazu Shneck Marina Shobab Leila Shulman Shiri Siachoque Heber Sijssens Karen Silva R Ulisses Silva-Cunha Armando Silveira A Claudio Silveira Claudio Silveira Claudio Silveira Claudio Silveira Cláudio Silver Phyllis B. Silvestri G Sims Joanne Singh Ramandeep Singh Ramandeep Singh S.J. Ravi Siqueira C Rubens Siqueira Rubens Siqueira Rubens Siqueira Rubens C Siqueira Rubens C Sirinyan M Sirtautiene Rasa Sirtautiene Rasa Sitompul Ratna Sizmaz Selcuk Sjamsoe Soedarman Smith Janine A. Smith Justine Smith Justine R. Smith Justine R. Smith R Justine Smith R. Justine Sng Chelvin Snir Moshe Sobrin Lucia Sonoda Koh-Hei Soubrane Gisele Soubrane Gisèle Souied Eric Souied Eric Souied Eric Souza Ana Catarina Delgado De Sow Mamadou Soydan Ender Soylu B. Merih Spinucci Giovanni Spire Myriam Sridharan Sudarshan Stanford M. R Stanford R Miles Stanford R Miles Stanojlovic S Starikova Viktorovna Alexandra Stein Harald Stein-Streilein Joan Stephen Teoh Stilma S. Jan Stirn Kranjc Branka Streho Mate Stuebiger Nicole Su Ling Ho Sugar Alan Sugita Sunao Sugita Sunao Sumadre Sandeep
RF2-24 PO3-18-02 PO2-30-02 PO3-21-04 RF1-21 OP8-06 RF2-22 PO2-23-05 OP2-05 OP7-08 PO3-17-01 OP7-08 OP7-09 OP8-05 PO2-23-11 P20-3 P5-4 PO2-11-10 RF1-22 OP11-02 PO3-28-01 PO2-12-02 PO3-17-04 PO1-22-09 PO2-10-04 PO3-17-05 PO3-17-01 P5-2 PO1-01-12 PO2-23-22 PO3-21-21 PO3-26-08 PO3-21-21 P1-2 OP4-05 P18-1 P1-2 P6-3 P2-2 PO2-10-08 OP2-03 OP4-07 PO1-04-13 OP4-02 OP4-01 OP4-01 OP4-02 P22-6 OP6-03 OP5-10 OP5-05 PO3-20-05 OP2-04 PO3-29-01 PO3-21-01 PO2-23-09 OP9-02 OP3-03 P14-3 PO1-01-04 P7-5 P5-6 PO3-21-19 OP2-05 PO2-23-25 PO2-23-30 PO1-04-01 PO3-21-19 S2-5 P20-1 PO2-30-02 OP5-08
Sun Deming Süren Elçin Suzuki Jun Suzuki Satoru Svozilkova Petra Szo Timea Szo Timea Tabbara Khalid F. Tae Gon Lee Tagawa Yoshitsugu Tagawa Yoshitsugu Takada Sonoko Takada Sonoko Takashi Kimoto Takemoto Yuko Takeuchi Masaru Takeuchi Masaru Taki Wakako Tandon R Tang Jun Taniguchi Hiroko Tannen Bradford Tano Yasuo Tano Yasuo Tano Yasuo Tant G Rezalina Tappeiner Christoph Tarasova N. Larisa Tarasova N. Larisa Taskapili Muhittin Taskintuna Ibrahim Ta?kıntuna Ibrahim Tau A Alejandro Tempesta Daniele Teoh Cb Stephen Teoh Stephen Teplova N. Svetlana Terrada Céline Terrada Céline Terrada Celine Terrada Céline Terrada Céline Tesavibul Nattaporn Tessler H. Howard Tessler Howard Tetsuya Nishimura Teus Guezala A Miguel Teus Guezala A Miguel Teus Guezala A Miguel Thabti Akram Thabti Akram Théoret Yves Thiemeyer Dorothea Thillaye-Goldenberg Brigitte Thomas Dhanes Thorne E Jennifer Thurau Stephan Tiwari A.N. Tognon Maria Sofia Tognon Maria Sofia Tognon Sofia Tognon Sofia Tojo Hiromasa Ton Yokrat Ton Yokrat Tordilla-Wadia Jennifer Torun Necip Torun Necip Torun Necip Toto Lisa Touchard E Touchard E
9th International Ocular Inflammation Society (IOIS) Congress September 17-20, 2007, Paris, France 199
OP4-10 PO3-19-09 PO3-26-03 PO1-05-01 PO2-23-03 PO2-23-28 PO3-18-03 S3-2 PO2-15-03 PO2-13-19 PO2-13-20 PO2-30-03 PO3-21-04 PO3-20-04 OP11-06 PO2-30-01 PO3-17-02 OP8-09 PO2-13-18 P5-4 OP5-14 RF1-16 RF1-23 PO1-04-02 PO1-05-03 RF2-24 PO3-24-08 PO1-01-06 PO1-02-06 PO1-03-09 PO3-26-09 PO2-23-15 PO1-03-10 PO2-23-31 PO3-19-08 OP9-10 PO1-02-06 PO1-01-09 PO1-22-10 P1-2 PO3-20-06 PO3-21-27 PO3-16-01 OP3-07 PO3-26-04 PO3-20-04 PO1-02-04 PO2-11-06 RF2-21 OP2-06 PO2-23-19 PO2-15-01 PO3-20-02 P17-4 PO2-23-09 OP4-07 PO1-05-09 PO3-19-01 OP3-02 PO3-26-02 PO3-21-03 P21-7 PO2-13-09 OP9-05 OP9-04 PO2-15-08 PO3-24-03 RF1-5 PO2-23-07 PO2-23-33 P17-6 P17-7
Abstract Book Touil - Boukoffa Chafia Touil-Boukoffa Chafia Touitou Valerie Toyoguchi Mitsuko Tran Chau Tran Thi Ha Chau Trigui Manal Trigui Manal Trinh Liem Trinh Liem Tritar Zohra Tritar Zohra Tufail Adnan Tugal-Tutkun Ilknur Tugal-Tutkun Ilknur Tugal-Tutkun Ilknur Tugal-Tutkun Ilknur Tugal-Tutkun Ilknur Tugal-Tutkun Ilknur Turki Fares Turki Fares Turki Khalil Turki Khalil Ubaldi A. Udaondo Mirete Patricia Udaondo Patricia Udaondo Patricia Udaondo Patricia Udaondo Patricia Udaondo Patricia Udaondo Patricia Uede Toshimitsu Ueno Hisayuki Ugo Murialdo Üretmen Önder Ursea Roxana Usui Masahiko Usui Yoshihiko Vaajanen Anu Vadala P. Vallochi L Adriana Vallochi L Adriana Valls Isabel Van De Vijver A.M.C. David Van Der Loos T Van Gelder Russell N. Van Hagen M P Van Hagen P. Martin Van Loon M Anton Van Loon M Anton Van Velthoven Mirjam Ej Vanathi M Vandamme Sebastien Vandergheynst Frédéric Vasconcelos-Santos Daniel Vaughan R. W. Vellaniparambil Raly Job Vengayil Sujith Venkatesh Pradeep Venkatesh Pradeep Venkatesh Pradeep Venkatesh Pradeep Venkatesh Pradeep Venkatesh Pradeep Venkatesh Pradeep Ventura Cabral De Catarina Ventura Cabral De Catarina Versura Piera Versura Piera Vidaller Palacin Antonio Vidovic Valentincic Natasa Virtanen Hannele
PO1-05-07 PO1-04-09 OP1-09 PO3-18-02 PO1-22-05 PO1-22-02 RF2-19 PO2-09-03 OP6-06 OP8-07 PO2-13-14 PO2-23-14 PO3-21-26 RF1-4 OP10-05 PO1-03-09 P4-2 P11B-3 P18-2 PO1-03-11 PO1-04-08 PO1-02-07 PO3-28-05 PO1-01-01 PO2-23-29 PO2-10-05 PO2-15-09 PO2-23-12 PO3-17-06 PO3-24-06 PO3-24-07 OP1-04 PO2-23-24 OP11-07 RF1-3 OP6-05 PO3-17-02 PO2-30-01 PO3-17-09 PO1-01-01 OP8-05 OP7-08 PO1-01-03 OP2-05 OP11-05 P6-4 OP11-05 P24P25-1 OP7-10 OP7-11 P11A-5 PO1-02-01 OP10-04 PO3-21-25 RF1-1 PO2-23-09 PO2-10-03 PO1-02-01 PO1-02-02 RF1-17 RF2-23 OP9-01 PO2-15-07 PO3-21-02 PO3-26-01 PO2-11-09 OP6-03 OP10-06 PO2-13-10 PO1-04-04 PO2-23-25 RF1-18
Viti Francesca Vleming Eduardo Vohra Rajpal Vohra Rajpal Vohra Rajpal Vrioni S Georgia Vugler Anthony Vukosavljevic S Miroslav Vukusic Sandra Wakefield Denis Wallace R Graham Wallon Martine Wallon Martine Wang Fang Wang Fang Wang Fang Wang Hong Wang Mingcong Wasilewicz Robert Watanabe Takayo Watkins Angela Weber Michel Wechsler Bertrand Wechsler Bertrand
PO1-22-08 PO2-23-23 PO1-02-02 OP9-01 PO3-26-01 PO3-26-10 PO3-21-26 PO3-21-15 PO3-18-01 P2-1 PO1-04-07 OP2-01 OP2-08 PO3-20-03 PO3-28-03 OP3-05 OP3-01 OP5-14 PO2-13-16 OP8-09 P1-2 OP4-09 OP3-08 PO1-04-12
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