Post on 20-Jun-2020
transcript
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Advances in Ophthalmology
Ramy Bassily
Consultant Ophthalmic Surgeon
Dry Eyes". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
DEWS II definition of dry eyes
7-16% of all adults over 481
1. Ophthalmic Epidemiol, 13 (2006), pp. 263-2742. Arch Ophthalmol. 2000 Sep; 118(9):1264-83. Oc Surf. 2016; 14(2):144-167
£820,930 per year for every 1000 dry eye patients2
Makes people miserable3
Dry Eyes". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
DEWS II definition of dry eyesMeasurable markers for diagnosis and treatment
- Osmolarity- MMPs
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 5851
The Dry Eye Questionnaire 5 (DEQ-5): Use of a 5-Item Habitual Symptom Score to Discriminate Between Groups With Varying Self-Assessed Severity
Improved diagnosis
Dry Eyes". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
DEWS II definition of dry eyes
Inflammation
Breaking the Vicious cycleOmega 3
Reduce inflammationIncrease tear production (up to 30%)Improve epithelial regeneration
All studies used EPA +1500mgDHA +500mg
Med Sci Mont 2014; 20: 1583–1589
Immunomodulating Drugs
• TRPV1 receptor antagonist (SYL1001)• Cyclosporine A• Tacrolimus• Tumor necrosis factor α-stimulated
gene/protein-6 (TSG-6)• Interleukin-1 receptor antagonist (IL-1Ra)• Anti tumor necrosis factor-α therapy (TNF- α)• Anti Interleukin-17 (IL-17) therapy• Neuropeptides• Lymphocyte function-associated antigen 1
(LFA-1) antagonist• Lifitegrast 5%
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Dry Eyes". . . a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
DEWS II definition of dry eyes
Nociceptors
Nasal neurostimulation Autologous serum /Fingerpick autologous blood
Corneal Transplants
Keratoconus
Corneal dystrophy Scars
Fuchs dystrophy
Corneal Transplants
Emergency Full Thickness Transplant for perforation from Herpes Simplex Keratitis
Corneal Transplants
DALKDeep Anterior Lamellar Keratoplasty
Reduce rejection ratesQuicker recovery
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Corneal Transplants With Femtolaser
Endothelial Corneal Transplants
• x20 fold reduction in rejection rates
• Recovery in 6 weeks (Vs 12 months)
DMEKDescment’s membrane Endothelial Keratoplasty
Endothelial Corneal TransplantsDMEKDescment’s membrane Endothelial Keratoplasty
• x20 fold reduction in rejection rates
• Recovery in 6 weeks (Vs 12 months)
Corneal transplants - the future
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Collagen cross linking• Developed 1997• In clinical use Italy 2005• NICE approved 2013• FDA approved 2016
85% success rate at stopping progression
Eye. 2015,29:1504
Started in Ipswich Aug 2017- 21 procedures
Femtosecond laserUltrashort pulse - Once 10-15 secs = No
collateral damage Intacs Radial keratectomies
Cataracts
IOL manipulation
Glaucoma
High IOP
Drops- Poor compliance- Ocular surface toxicity- Poor response Selective laser trabeculoplasty
+/-
>20% continue to progress
TrabeculectomyCystic leaking bleb Blebitis
Minimally invasive glaucoma surgeryMIGS
I-stent
Trabeculome
Hydrus stent
Cypass
Xen implant