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Contents Forewords Prince Abdulaziz Ahmed Abdulaziz Al-Saud ........................................................................ 1 Dr Abdul Elah Abad Al-Towerki ............................................................................................ 2 Conference at a Glance ................................................................................................................ 3 Floor Plan ...................................................................................................................................... 4 Speakers International Guest Speakers .............................................................................................. 6 Presenters ............................................................................................................................ 7 Symposium Committees ............................................................................................................. 11 Scientific Program Monday, March 7 ................................................................................................................ 14 Tuesday, March 8 ............................................................................................................... 17 Wednesday, March 9 ......................................................................................................... 21 Thursday, March 10 ........................................................................................................... 25 Poster Presentations .......................................................................................................... 28 Video Presentations ........................................................................................................... 30 Abstracts Monday, March 7 ................................................................................................................ 31 Tuesday, March 8 ............................................................................................................... 32 Wednesday, March 9 ......................................................................................................... 40 Thursday, March 10 ........................................................................................................... 51 Posters ............................................................................................................................... 63 Videos ................................................................................................................................ 72 Participating Organizations and Exhibitors ................................................................................. 76 Saudi Ophthalmology 2016: Program and Abstracts Foreword W elcome to Saudi Ophthalmology 2016 (SO 2016), a combined meeting of the 28th Annual Scientific Meeting of the Saudi Ophthalmological Society (SOS) and 33rd Annual Symposium of the King Khaled Eye Specialist Hospital (KKESH) in collaboration with the Department of Ophthalmology, College of Medicine, King Saud University (KSU). This combined annual meeting is an educational activity that continues to build a proud tradition of service in the Kingdom of Saudi Arabia and to its neighboring countries, striving to serve as a bridge for ophthalmological innovation. Prince Abdulaziz bin Ahmed bin Abdulaziz Al Saud President, SOS Since the establishment of SOS on 16th September 1985, being one of the first Saudi Scientific Medical Societies and the only ophthalmological to be formed, ophthalmologists in the Kingdom of Saudi Arabia. Under the leadership of the Custodian of the Two Holy Mosques, King Salman bin Abdulaziz Al Saud, and Honorary President of SOS HRH Prince Ahmed bin Abdulaziz Al Saud, the Society continues to strive to achieve its future goals. This is in accordance with our government’s mandate to raise the scientific standards of ophthalmology personnel, as well as the quality of eye care services provided to our patients. This is the 18th combined scientific meeting of the two leading organizations, SOS and KKESH, in collaboration with KSU. We continue to unite our efforts and goals to provide the strongest and most comprehensive meeting in the region, in order to better serve ophthalmologists and optometrists. The SO 2016 will focus on the new developments in: Anterior Segment, Retina, Optometry, Prevention of Blindness, Pediatric Ophthalmology and Neuro Ophthalmology through lectures, courses, posters and video presentations as well as workshops. We are grateful to our international and local speakers for sharing their clinical experiences and research with us. This year’s exhibition will feature the latest technology from leading companies in the region. The exhibition will cover a wide array of ophthalmic equipment and supplies. The Saudi Journal of Ophthalmology (SJO) is an English language, peer-reviewed scholarly publication in the area of ophthalmology. It is the official journal of the SOS and publishes original research papers, clinical studies, review articles and case report on a quarterly basis. SJO is indexed with PubMed and SCOPUS – popular scientific databases and search engines. It is also available on Science Direct. The journal was founded in 1986 and has a rich history in serving the ophthalmic community in the Kingdom, Gulf States and the Middle East. It is an open access journal and all the articles are available free of charge to readers. The society distributes 2000 print copies of the journal free of charge to all SOS members in the Kingdom and aboard, in addition to many ophthalmologists, medical organizations and medical schools, globally. The society strives continuously to enrich scientific research by presenting an award for the best published research by its members. I would like to express my personal gratitude to HE Eng. Khalid bin Abdulaziz Al-Falih, Minister of Health, Executive Director of KKESH and Dean, College of Medicine and Supervisor of the University Hospitals, KSU for their continuous support of our activities in general and this meeting in particular. I would also like to thank the Steering, Scientific and Organizing committees for their genuine efforts and dedication in organizing Saudi Ophthalmology 2016. Saudi Ophthalmology 2016: Program and Abstracts 1 Foreword On behalf of King Khaled Eye Specialist Hospital (KKESH), I would like to welcome you to the 33rd Annual Symposium of KKESH jointly convened with the 28th Scientific Meeting of the Saudi Ophthalmological Society (SOS) in collaboration with King Saud University (KSU). KKESH has played a key role in organizing the annual meeting since 1982, in which the latest developments in ophthalmic medicine and surgery are reviewed. HRH Prince Abdulaziz bin Ahmed bin Abdulaziz Al Saud, President of SOS, has been an enthusiastic facilitator and leader in unifying the scientific efforts, Dr AbdulElah Abad into one convention for the greater benefit of Ophthalmic care providers in Saudi Arabia Al-Towerki and neighboring countries. This year’s meeting will focus on: Cataract, Cornea & RefracGen. Exec. Director, KKESH tive Surgery, Prevention of Blindness, Optometry, Retina, Pediatric Ophthalmology and Neuro-Ophthalmology. A large number of world renowned experts in these subspecialties, from Saudi Arabia and other countries, will participate in this gathering. Evelyn Annette Paysse, MD, will present the King Khaled Memorial Lecture. The mission entrusted to KKESH is not limited to providing patient care, but also extends to education, training and research. The Department of Medical Education plays a significant role in keeping ophthalmologists in the region abreast of the latest developments in their field, providing the educational programs of the highest caliber such as the weekly Regularly Scheduled Conferences Program, the Annual Ophthalmology Symposium, the International Visitors Program as well as Clinical Training/Observership Programs. The International Visitors Program brought several globally renowned clinicians and scientists to KKESH who contributed to our efforts in providing the highest standards of clinical care, new therapies and research ideas. The Department of Medical Education at KKESH also continues its strong commitment to the Residency program in Ophthalmology since its inception in 1984 in collaboration with KSU. The program, under the umbrella of Saudi Commission for Health Specialties has trained two hundred and eighty (280) ophthalmologists to date. In 2015, the KKESH Residency Program was accredited by the Saudi Commission for Health Specialties wherein the hospital accepted the 1st batch of 8 first year KKESH residents. Our KKESH Subspecialty Fellowship Program, which was launched in 1994, has graduated two hundred and eighty eight (288) ophthalmology subspecialists. In 2013, the KKESH Fellowship Subspecialty Program was accredited in 7 Subspecialties by the Saudi Commission for Health Specialties as the first Saudi Ophthalmology Subspecialty Fellowship Program. In 2015, the 2nd batch of fellows at KKESH graduated from the accredited Saudi Ophthalmology Subspecialty Fellowship Program, which is the 21st batch that graduated from the KKESH Subspecialty Fellowship Program. I would like to thank the Associate Medical Director of Education and the Director of the Residency Program for their relentless efforts in training and promoting continuing medical education programs. The Department of Training and Scholarship at KKESH provides training and education of crucial importance that contributes to the professional development and competency of our Technical and Support Staff. In the area of Research, KKESH has taken large strides and gained increasing visibility as an elite research center that is recognized globally. Intramural research efforts have been expanded and so have our collaborations with institutions around the world. KKESH is now a participant in two multicenter international clinical trials funded by the National Eye Institute, USA. Our thanks are extended to all our physicians who diligently contribute to the research endeavor through publications in indexed journals and presentations at major scientific meetings. With the continued generous and unwavering support of the Government of the Custodian of The Two Holy Mosques, the Crown Prince and the sound management of His Excellency the Minister of Health we have continued to realize our mission of patient care, teaching and research. I would like to thank HRH Prince Abdulaziz bin Ahmed bin Abdulaziz Al Saud, President of the Saudi Ophthalmological Society and Regional Chair of the International Agency for the Prevention of Blindness, for his efforts to improve ophthalmology in the Kingdom and for his unlimited contribution that aims to prevent blindness nationally regionally, and internationally. I would also like to extend my thanks to our colleagues in the Saudi Ophthalmological Society for their effective participation in this conference, and the Symposium Committees and all medical companies who have supported this symposium. I pray to God Almighty that this medical and scientific gathering will be benefit all the participants and will contribute to the upgrading of health standards in this country. 2 Saudi Ophthalmology 2016: Program and Abstracts Conference at a Glance Saudi Ophthalmology 2016: Program and Abstracts 3 4 Saudi Ophthalmology 2016: Program and Abstracts Program and Abstracts Book Prepared By: Mohammed Mohsin Assistant Editor Saudi Journal of Ophthalmology (SJO) Rana Al-Shubaian Administrative Assistant I Medical Education Department, King Khaled Eye Specialist Hospital Under the Supervision of: Ali A. Al-Rajhi, MD, FRCS, FRCOphth Chief, Continuous Medical Education Committee, Saudi Ophthalmology Society Professor, College of Medicine, Al Faisal University Senior Consultant Ophthalmologist, Al Hokama Eye Specialist Center and Magrabi Hospital, Riyadh Editor-in-Chief, Saudi Journal of Ophhalmology (SJO) Abdullah G. Al-Otaibi, MD Deputy President, Saudi Ophthalmological Society (SOS) Assistant Professor and Consultant, Pediatric Ophthalmology Division Department of Ophthalmology, College of Medicine, King Saud University (KSU), Riyadh Eman Al-Kahtani, MD Associate Medical Director of Education Consultant, Vitreoretinal Disease and Surgery Division Program Director, Saudi Ophthalmology Subspecialty Fellowship Program Co-Chair, Scientific Program Committee/Saudi Ophthalmology Conference, King Khaled Eye Specialist Hospital, Riyadh Saudi Ophthalmology 2016: Program and Abstracts 5 International Guest Speakers King Khaled Memorial Lecturer Evelyn Annette Paysse, MD Professor, Department of Ophthalmology Baylor College of Medicine Houston, TX, US Physician, Texas Children’s Hospital Clinical Care Center Saudi Ophthalmology Society Gold Medal Lecturer Stephen R. Russell, MD Service Director, Vitreoretinal Diseases and Surgery Dina J Schrage Professor of Macular Degeneration Research Professor of Ophthalmology and Visual Sciences Prof Alan William Johnston Principal Optometrist East Melbourne Optometry & Low Vision Centre Australia Michael Kalloniatis, BSc (Optom), PGCerOculTher (Melb), PhD (Houston), FAAO Director and Professor of Optometry and Vision Science Centre for Eye Health, UNSW, Australia David Kevin Coats, MD Professor of Ophthalmology and Pediatrics Baylor College of Medicine Chief of Service/Section Chief – Ophthalmology Texas Children’s Hospital, USA Rajendra Shridhar Apte, MD Director of Education Assistant Professor of Ophthalmology and Visual Science Department of Ophthalmology and Visual Sciences Washington University School of Medicine, USA Fion Domnall Bremner, MD, MSc, MBBS, PhD, FRCOphth NHS Consultant Ophthalmic Surgeon University College Hospital, the Royal Free Hospital and the National Hospital for Neurology and Neurosurgery, London, UK 6 Patrick YU WAI MAN, MD MRC Clinician Scientist/Clinical Senior Lecturer/ Honorary Consultant Ophthalmologist Wellcome Trust Centre for Mitochondrial Research Institute of Genetic Medicine Newcastle University, UK Stephen Dale McLeod, MD Professor Chair of the Ophthalmology Department at UCSF Specializes in Refractive Surgery, Cataract and Corneal Disease University of California San Francisco, USA Elmer Tu, MD Professor of Clinical Ophthalmology Director, Cornea Service Illinois Eye and Ear Infirmary Chicago, Illinois, USA Muhammad Babar Qureshi, MD Chief Executive Officer/ Executive Director Comprehensive Health and Education Forum International (CHEF Int’l), Senior Medical Advisor CBM, Board Member of International Council of Ophthalmology, Chair ICO Task Force on Uncorrected refractive errors, CoChair IAPB – EMR and Chair EMR-HRWG Saudi Ophthalmology 2016: Program and Abstracts Presenters Abdullah A. Al-Marshood, MD 4th Year Program Resident and Chief of Program Residents Eastern Province Ophthalmology Training Program, KSA Alicia Galindo, MD Senior Consultant Oculoplastics and Orbit Division King Khaled Eye Specialist Hospital, Riyadh, KSA Abdullah Assiri, MD Senior Consultant Ophthalmologist Cornea, Refractive (Lasik) and Cataract Clinical Asst. Professor, King Saud University Magrabi Hospital, Riyadh, KSA Alka Mahale, PhD Senior Research Scientist Research Department King Khaled Eye Specialist Hospital, Riyadh, KSA Abdulrahman Al-Jasser, MBBS Medical Intern King Saud University, Riyadh, KSA Amal Al-Humaidan, MD, FRCS (ED) Consultant Pediatric Ophthalmology and Strabismus King Faisal Specialist and Research Center, Riyadh, KSA Abdulrahman Al-Oraini Ophthalmic Photographer King Khaled Eye Specialist Hospital, Riyadh, KSA Amr Radwan, MD Assistant Lecturer Faculty of Medicine, Alexandria University, Egypt Abdulrahman Al-Bloushi, MD Ophthalmology Resident Joint Residency Training Program, Riyadh Center Athari Al-Duraibi Optometrist, MSc in Health and Hospital Administration Acting Chief of Optometry King Khaled Eye Specialist Hospital, Riyadh, KSA Abdulaziz Al-Dhafeeri, MBBS Medical Intern UOD, KFHU Adel Al-Akeely, MD Vitreoretinal Fellow King Khaled Eye Specialist Hospital, Riyadh, KSA Ahmad Al-Ghamdi, COMT Technical Instructor, Training and Scholoarship Program King Khaled Eye Specialist Hospital, Riyadh, KSA Ahmed Abu El-Asrar, MD, PhD Professor and Consultant Ophthalmologist Chief of Vitreoretinal Division Department of Ophthalmology, College of Medicine King Saud University, Riyadh, KSA Ahmed Al-Yahya, MD Ophthalmology Resident Joint Residency Program in Ophthalmology, Riyadh Center Alberto Galvez, MD Senior Consultant Neuro-Ophthalmology Division King Khaled Eye Specialist Hospital, Riyadh, KSA Ali Al-Halafi, MD Consultant Vitreo-Retinal Surgeon Department of Ophthalmology Security Forces Hospital, Riyadh, KSA Awad Al-Qarni, MD Associate Consultant Member, Anterior Segment Division King Khaled Eye Specialist Hospital, Riyadh, KSA Bader Al-Qahtani, MBBS Medical Intern King Saud bin Abdulaziz University for Health Sciences, KSA Bassima Aldulaigan, OD Chief of Optometry Department AlRaed Consultant Medical Center, KSA Craig Simms Supervisor and Chief Ophthalmic Medical Technologist Hotel Dieu Hospital, Department of Ophthalmology Kingston, Ontario, Canada David Gritz, MD Professor of Ophthalmology and Epidemiology (PAR) Wilmer Eye Institute Dana Center for Preventive Ophthalmology Johns Hopkins University School of Medicine Johns Hopkins University School of Public Health Baltimore, MD Chief of Anterior Segment Division King Khaled Eye Specialist Hospital, Riyadh, KSA Saudi Ophthalmology 2016: Program and Abstracts 7 Deepak Edward, MD Senior Academic Consultant Executive Medical Director Member, Glaucoma Division King Khaled Eye Specialist Hospital, Riyadh, KSA Jonas S. Friedenwald Professor of Ophthalmology Wilmer Eye Institute Professor of Pathology, Johns Hopkins University School of Medicine Baltimore, MD, USA Igor Kozak, MD Senior Academic Consultant Vitreoretinal Division King Khaled Eye Specialist Hospital, Riyadh, KSA Donald Stone, MD Director, Research Department Senior Consultant, Anterior Segment Division King Khaled Eye Specialist Hospital, Riyadh, KSA Jesus Pintor, MD Full Professor Department of Biochemistry and Molecular Biology IV Faculty of Optics and Optometry Universidad Complutense De Madrid, Spain Eman Al-Kahtani, MD Associate Medical Director of Education Consultant, Vitreoretinal Disease & Surgery Division Program Director, Saudi Ophthalmology Subspecialty Fellowship Program Co-Chair, Scientific Program Committee/Saudi Ophthalmology Conference King Khaled Eye Specialist Hospital, Riyadh, KSA Eman Al-Sharif, MD Ophthalmology Resident (R1) King Abdulaziz University Hospital, King Saud University, KSA Enrique Suarez, MD Senior Academic Consultant, Anterior Segment Division King Khaled Eye Specialist Hospital, Riyadh, KSA Hany Helaly, MD Lecturer of Ophthalmology Alexandria University, Egypt Hassan Al-Dhibi, MD Senior Academic Consultant Chief, Uveitis Division Member, Vitreoretinal Division King Khaled Eye Specialist Hospital, Riyadh, KSA Heba Khashoggi, MSc Orthoptics Orthoptist, OPS Member of Australian Orthoptic Association King Khaled Eye Specialist Hospital, Riyadh, KSA Helmieh Fayad, COMT Technical Instructor Monitoring Department King Khaled Eye Specialist Hospital, Riyadh, KSA 8 Jose Vargas, MD Consultant and Member Anterior Segment Division King Khaled Eye Specialist Hospital, Riyadh, KSA Khaled Al-Arfaj, MD Assistant Professor Chairman of Ophthalmology Department Dammam University, KSA Khalid Al-Husseiny, MD Vitreoretinal Consultant Cairo University, Egypt Riyadh Eye Center, KSA Khalid Jamous, MOptom, PhD Low Vision Consultant Chief of Optometry Unit King Saud Medical City, Riyadh, KSA Hanan Al-Kozi, MD Huda Al-Dhaheri, MD Anterior Segment Consultant Tawam Hospital, Al-Ain, UAE Ismael Al-Ghamdi, MD Pediatric Ophthalmologist Department of Ophthalmology, College of Medicine King Saud University, Riyadh, KSA Laila Al-Ghaferi, MD Oculoplastics and Orbit Fellow King Khaled Eye Specialist Hospital, Riyadh, KSA Leen Safieh, PhD Senior Research Scientist Research Department King Khaled Eye Specialist Hospital, Riyadh, KSA Leyla Al-Jasim, MD Consultant I Glaucoma Division King Khaled Eye Specialist Hospital, Riyadh, KSA Majid Abalkhail, MBBS Medical Intern King Abdulaziz Hospital, Jeddah, KSA Manal Al-Harbi, MS, Optometrist Lecturer at King Saud University, Riyadh, KSA Saudi Ophthalmology 2016: Program and Abstracts Marco Mura, MD Senior Academic Consultant Chief, Vitreoretinal Division King Khaled Eye Specialist Hospital, Riyadh, KSA Marwan Abouammoh, MD Associate Professor and Consultant Ophthalmologist Vitreo-Retinal Division Department of Ophthalmology, College of Medicine King Saud University, Riyadh, KSA Md. Anwarul Azim, MD Director General and Chief Physician Doctor Azim Ltd., Moscow, Russian Federation Medhat Eldakhakhny, MD Consultant Pulmonologist and Hyperbaric Physician King Abdulaziz Hospital, Jeddah, KSA Mohammad Al-Ahmari, COMT Acting Manager Case Management Department King Khaled Eye Specialist Hospital, Riyadh, KSA Mohammad El Banna Visual Field Technician Outpatient Services King Khaled Eye Specialist Hospital, Riyadh, KSA Mohammad Ghulam, PhD Assistant Professor Department of Ophthalmology, College of Medicine King Saud University, KSA Mohammad Asiri, MD Vitreoretinal Fellow King Khaled Eye Specialist Hospital, Riyadh, KSA Mohammed AbaHussain, M.Optom, PhD, FBCLA Consultant and Assistant Professor Optometry Department, King Saud University, Riyadh, KSA Mohammed Al-Blowi Optometrist Optometry Division King Khaled Eye Specialist Hospital, Riyadh, KSA Mohammed Badran Ocularist OPC Department King Khaled Eye Specialist Hospital, Riyadh, KSA Mohammed Shaikh, MD Consultant Ophthalmologist Moneera Al-Ogla Optometrist Private Medical Center Nayef Al-Ateeq Electrophysiologist Outpatient Services King Khaled Eye Specialist Hospital, Riyadh, KSA Noor Al-Anazi, MBBS Medical Intern King Saud University, KSA Omar Abdulsalam, MD Vitreoretinal Fellow King Khaled Eye Specialist Hospital, Riyadh, KSA Omar Basamh, MD Pediatric Ophthalmology Fellow King Khaled Eye Specialist Hospital, Riyadh, KSA Omar Husain, MD Ophthalmology Resident Joint Residency Training Program in Ophthalmology Riyadh Center, KSA Patrick Schatz, MD Senior Consultant Vitreoretinal Division King Khaled Eye Specialist Hospital, Riyadh, KSA Raghad Al-Rasheed 5TH Year Medical Student King Saud University, KSA Raja Hariz Chief of Ultrasound King Abdulaziz University Hospital, KSA Reem Al-Ahmadi, MBBS Medical Intern King Saud University, KSA Reem Al-Qhahtani, MSc. Optometry Practicing Senior Optometrist King Abdulaziz University Hospital, Riyadh, KSA Reham Al-Qahtani, MBBS Medical Intern King Saud bin Abdulaziz University for Health Sciences, KSA Rizwan Malik, MD Consultant I Member, Glaucoma Division King Khaled Eye Specialist Hospital, Riyadh, KSA Saudi Ophthalmology 2016: Program and Abstracts 9 Saad Al-Thiabi, MD Resident Qassim University, KSA Shaban Shaban, COT Senior Technical Instructor Training and Scholarship Department King Khaled Eye Specialist Hospital, Riyadh, KSA Saba Al-Rashaed, MD Senior Consultant Associate Chief, Vitreoretinal Division King Khaled Eye Specialist Hospital, Riyadh, KSA Said JamalEddin, MD Specialist Ophthalmologist Baish General Hospital, Jizan, KSA Salwa Al-Shibani, MBBS Medical Intern King Saud University, KSA Samir Shoughy, MD, FRCS Ophthalmologist Subspecialized in Uveitis The Eye Center, Riyadh, KSA Sara Al-Ohali, MSc Optometrist I Contact Lens Specialist King Fahad Medical City, KSA 10 Tariq Al-Hamad, PhD Vice Dean for Academic Affairs Consultant and Asst Prof of Cornea and Clinical Optometry College of Applied Medical Sciences Qassim University, KSA Turki Dakhil, MD Anterior Segment Fellow King Khaled Eye Specialist Hospital, Riyadh, KSA Waleed Al-Rashed, MD Head of Ophthalmology Department Collage of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, KSA William Ehlers, MD Staff Physician, UCONN Health Associate Professor, University of Connecticut Medical School, USA Zainab Al-Khodairi, MSc Orthoptics Certified Dyslexic Therapist King Fahad University Hospital, Alkhobar, KSA Saudi Ophthalmology 2016: Program and Abstracts Symposium Committees HRH Prince Abdulaziz Ahmed Abdulaziz Al Saud President, Saudi Ophthalmological Society (SOS) Board of Trustees Member, International Agency for the Prevention of Blindness (IAPB) and Chair, Eastern Mediterranean Region (EMR) AbdulElah Abad Al-Towerki, MD Senior Academic Consultant Anterior Segment Division; Cornea, Refractive Surgery General Executive Director King Khaled Eye Specialist Hospital (KKESH) Adel Al-Suhaibani, MD, FRCS, MSc HCM Professor and Consultant Ophthalmologist Chairman, Department of Ophthalmology College of Medicine, King Saud University, Riyadh, KSA Steering Committee Chairs: Abdullah Al-Otaibi, MD Deputy President, Saudi Ophthalmology Society Assistant Professor Consultant Pediatric Ophthalmology Department of Ophthalmology, College of Medicine King Saud University, Riyadh, KSA Deepak Edward, MD Executive Medical Director Senior Academic Consultant Member, Glaucoma Division King Khaled Eye Specialist Hospital, Riyadh, KSA Jonas S. Friedenwald Professor of Ophthalmology, Wilmer Eye Institute Professor of Pathology, Johns Hopkins University School of Medicine Baltimore, MD, USA Ahmed Al-Eid Symposium Affairs Coordinator Training & Scholarship Department King Khaled Eye Specialist Hospital, Riyadh, KSA Mohammed Fasihuddin Registration and Exhibitions Coordinator Saudi Ophthalmology Society, Riyadh, KSA Rana Al-Shubaian Administrative Assistant Medical Education Department King Khaled Eye Specialist Hospital, Riyadh, KSA Scientific Program Committee Members: Chairs: Eman Al-Kahtani, MD Associate Medical Director of Education Consultant, Vitreoretinal Disease and Surgery Division Program Director, Saudi Ophthalmology Subspecialty Fellowship Program Co-Chair, Scientific Program Committee/Saudi Ophthalmology Conference King Khaled Eye Specialist Hospital, Riyadh, KSA Ali Al-Rajhi, MD Chief, Continuous Medical Education Committee Saudi Ophthalmology Society, Riyadh, KSA Professor, College of Medicine, Al Faisal University Senior Consultant Ophthalmologist, Al Hokama Eye Specialist Center and Magrabi Hospital, Riyadh, KSA Eman Al-Kahtani, MD Associate Medical Director of Education Consultant, Vitreoretinal Disease & Surgery Division Program Director, Saudi Ophthalmology Subspecialty Fellowship Program Co-Chair, Scientific Program Committee/Saudi Ophthalmology Conference King Khaled Eye Specialist Hospital, Riyadh, KSA Ali Al-Rajhi, MD Chief, Continuous Medical Education Committee Saudi Ophthalmology Society, Riyadh, KSA Professor, College of Medicine, Al Faisal University Senior Consultant Ophthalmologist, Al Hokama Eye Specialist Center and Magrabi Hospital, Riyadh, KSA Saudi Ophthalmology 2016: Program and Abstracts 11 Adel Al-Suhaibani, MD, FRCS, MSc HCM Professor and Consultant Ophthalmologist Chairman, Department of Ophthalmology College of Medicine, King Saud University, Riyadh, KSA Ismael Al-Ghamdi, MD Pediatric Ophthalmologist Department of Ophthalmology, College of Medicine King Saud University, Riyadh, KSA Members: Lina Al-Kahmous, MSc, OC(C) Canadian Certified Orthoptist Senior Orthoptist, Pediatric Ophthalmology Department King Khaled Eye Specialist Hospital, Riyadh, KSA Mohammad Al-Amry, MD Senior Consultant Anterior Segment Divison King Khaled Eye Specialist Hospital, Riyadh, KSA Majed Al-Kharashi, MD Assistant Professor and Consultant Ophthalmologist Cornea, External Disease and Refractive Surgery Division Department of Ophthalmology, College of Medicine King Saud University, Riyadh, KSA Abdullah Al-Assiri, MD Senior Consultant Ophthalmologist Cornea, Refractive (Lasik) and Cataract Clinical Ass. Professor, King Saud University Magrabi Hospital, Riyadh, KSA Igor Kozak, MD Senior Academic Consultant Member, Vitreoretinal Division King Khaled Eye Specialist Hospital, Riyadh, KSA Marwan Abouammoh, MD Associate Professor and Consultant Ophthalmologist Vitreo-Retinal Division, Department of Ophthalmology College of Medicine, King Saud University, Riyadh, KSA Ali Al-Halafi, MD, FRSC Consultant Vitreo-Retinal Surgeon Department of Ophthalmology Security Forces Hospital, Riyadh, KSA Alberto Galvez, MD Senior Consultant Member, Neuro-Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, KSA Thomas Bosley, MD Professor and Consultant Ophthalmologist Neuro-Ophthalmology, Department of Ophthalmology College of Medicine, King Saud University, Riyadh, KSA Maha Badr, MD Senior Clinical Consultant Neuro-Ophthalmology Prince Sultan Military Medical City, Riyadh, KSA Mohammed Al-Shamrani, MD Consultant I Member, Pediatric Ophthalmology King Khaled Eye Specialist, Riyadh, KSA 12 Khalid Jamous, MOptom, PhD Low Vision Consultant King Saud Medical City, Riyadh, KSA Khaled Al-Arfaj, MD Assistant Professor Chairman of Ophthalmology Department Dammam University, KSA Mohammed Fasihuddin Registration and Exhibitions Coordinator Saudi Ophthalmology Society, Riyadh, KSA Rana Al-Shubaian Administrative Assistant Medical Education Department King Khaled Eye Specialist Hospital, Riyadh, KSA Organizing Committee Chair: Abdullah Otaibi, MD Deputy President, Saudi Ophthalmological Society Associate Professor and Consultant Pediatric Ophthalmology Division Department of Ophthalmology, College of Medicine King Saud University, Riyadh, KSA Members: Eman Al-Kahtani, MD Associate Medical Director of Education Consultant, Vitreoretinal Disease & Surgery Division Program Director, Saudi Ophthalmology Subspecialty Fellowship Program Co-Chair, Scientific Program Committee/Saudi Ophthalmology Conference King Khaled Eye Specialist Hospital, Riyadh, KSA Abdulrahman Al-Faran, MD Chief, Ophthalmic Unit, KKUH Assistant Professor and Consultant VitreoRetinal Division, Department of Ophthalmology College of Medicine, King Saud University, Riyadh, KSA Saudi Ophthalmology 2016: Program and Abstracts Waseem Aalam, MD Assistant Professor Ophthalmologist, Cornea Cataract, Refractive Surgery Taibah University, KSA Adolph Cabanas Senior Graphic Designer Design and Publications Department King Khaled Eye Specialist Hospital, Riyadh, KSA Abdulaziz Al-Huthaili Director, Protocol, Public Relations and Information King Khaled Eye Specialist Hospital, Riyadh, KSA Ahmed Al-Eid Symposium Affairs Coordinator Training & Scholarship Department King Khaled Eye Specialist Hospital, Riyadh, KSA Ahmed Al-Eid Training and Symposium Affairs Coordinator Training and Scholarship Department King Khaled Eye Specialist Hospital, Riyadh, KSA Maria Pabillano Secretary, Medical Education Department King Khaled Eye Specialist Hospital, Riyadh, KSA Mohammed Fasihuddin Registration and Exhibition Coordinator Saudi Ophthalmology Society, Riyadh, KSA Coordinators Rana Al-Shubaian Administrative Assistant Medical Education Department King Khaled Eye Specialist Hospital, Riyadh, KSA SO 2016 Program Office Mohammed Fasihuddin – Registration and Exhibition Rana Al-Shubaian – Administrative Assistant I Maria Pabillano – Secretary Michelle Rasonabe – Medical Secretary Majed Wahbi Public Relations Manager Saudi Ophthalmological Society, Riyadh, KSA Saud Zahrani Manager Medical Television King Khaled Eye Specialist Hospital, Riyadh, KSA Karam Hamweyah, MBBS Research Fellow Research Department King Khaled Eye Specialist Hospital, Riyadh, KSA Poster Committee Rana Al-Shubaian Administrative Assistant Medical Education Department King Khaled Eye Specialist Hospital, Riyadh, KSA Sahar Al-Sarhan Programmer/Analyst Information Technology Department King Khaled Eye Specialist Hospital, Riyadh, KSA Conference Website Rana Al-Shubaian – Administrative Assistant I, KKESH Fahad Al-Qahtani – System Developer, KKESH Sahar Al-Sarhan – Programmer/Analyst, KKESH Audio Visual Saud Al-Zahrani – Manager Medical Television, KKESH Ali Al-Kahtani – Audio Visual Technician, KKESH Majed Al-Wadaani – Audio Visual Technician, KKESH Yihia Zakariya – Audio Visual Coordinator, Riyadh, KSA Public Relations Abdulaziz Al-Huthaili – Director of Protocol, Public Relations and Information, KKESH Abdullah Al-Salman, PhD – Hospital Advisor, Protocol, Public Relations and Information, KKESH Maged Wahbi – Public Relations Manager, SOS Additional Services Mohammed Fasihuddin – Registration and Exhibition, SOS Abdullah Al-Dossari – Acting Director, Security, KKESH Mohammed Al-Wadani – Coordinator, Training and Scholarship Department, KKESH Saudi Ophthalmology 2016: Program and Abstracts 13 Program Monday, March 7 M1A Moderator 3rd Ophthalmic Technical Seminar (Auditorium A) Jamal Al-Raaei, COA 08:30 - 09:00 Corneal Topography Mohammed Al-Ahmari, COMT Wave Front Technology in Refractive Surgery: Concepts and Applications Dr. William Ehlers Post refractive Surgery IOL Calculations Mr. Craig Simms 09:00 - 09:30 09:30 - 10:00 M1C Moderator Neuro Ophthalmology Workshop (Auditorium C) Alberto Galvez, MD 08:30 - 08:55 09:45 - 10:00 Leber Hereditary Optic Neuropathy Patrick YU WAI MAN, MD Autosomal Dominant Optic Atrophy Patrick YU WAI MAN, MD Other Inherited Optic Neuropathies Patrick YU WAI MAN, MD Discussion 10:00 - 10:20 Break M2A Moderator 3rd Ophthalmic Technical Seminar (Auditorium A) Shaban M. Shaban, COT 10:20 - 11:10 Difficult Refractions Dr. William Ehlers Implantable Contact Lens Shaban M. Shaban, COT Aphakic Spectacles Ahmad Al-Ghamdi, COMT 08:55 - 09:20 09:20 - 09:45 11:10 - 11:40 11:40 - 12:00 M2B Chair Moderator Pediatric Ophthalmology Workshop (Auditorium B) Mohammad Al-Shamrani, MD Dora Al-Harkan, MD; Amani Al-Bakri, MD 10:20 - 12:00 Pediatric IOL Implantation 14 Saudi Ophthalmology 2016: Program and Abstracts M2C Chair Moderator Optometry - Contact Lenses (Auditorium C) Tariq Al-Hamad, PhD Muneera Al-Ogla, Optometrist 10:20 - 10:35 11:55 - 12:00 Post- Penetrating Keratoplasty Hard Contact Lenses Fitting Muneera Al-Ogla, Optometrist In Vitro and In Vivo Delivery of The Secretagogue Diadenosine Tetraphosphate from Conventional and Silicone Contact Lensesses Dr. Jesus Pintor Fitting Strategies for Keratoconus Bassima Al-Dulaigan, OD Fitting Keratoconus Patients with Soft CL: Case Presentation Athari Al-Duraibi, Optometrist, Msc Contact Lenses and Corneal Hypoxia, What Is The Minimum DK/t Mohammed Abahussain, M.Otom, PhD, FBCLA Compare between Different Types of Contact Lenses and How They Influence The Biomechanica Properties of The Cornea Tariq Al-Hamad, PhD Discussion M3A Moderator 3rd Ophthalmic Technical Seminar (Auditorium A) Mohammed Al-Ahmari, COMT 12:45 - 13:15 Keratoconus Donald Stone, MD Contact lenses: Keratoconus, Penetrating Keratoplasty and post refractive surgery Dr. William Ehlers Anterior Segment Pathology Imaged with UBM Mr. Craig Simms Ophthalmic Technical Programs in Canada Mr. Craig Simms Visual Field Testing with The Humphery Field Analyzer Mohammad El Banna 10:35 - 10:50 10:50 - 11:10 11:10 - 11:25 11:25 - 11:40 11:40 - 11:55 13:15 - 13:50 13:50 - 14:20 14:20 - 14:45 14:45 - 15:20 M3B Moderator Optometry - Orthopic & Free Paper (Auditorium B) Lina Al-Kahmous, Senior Orthoptist 13:30 - 13:45 15:10 - 15:20 Comparison of The Value of The Phenol Red Thread Test With and Without Topical Anaesthesia in Normal Adults Sara Al-Ohali, Optometrist, MSc of Optometry A and V Patterns Heba Khashoggi, MSc Orthoptics A Comparison of EFG Therapy vs Patching for the Treatment of Amblyopia in Children Aged 9-17 Years Manal Al-Harbi, MSc Optometry Orthoptic Role in Bilaterall 6th Nerve Palsy Zainab Al-Khodairi, MSc Orthoptics New Evidence-based Guidelines for Amblyopia Treatment Bassima Al-Dulaigan, OD Discussion 12:00 - 12:45 Lunch 13:45 - 14:05 14:05 - 14:25 14:25 - 14:50 14:50 - 15:10 Saudi Ophthalmology 2016: Program and Abstracts 15 M3C Moderator Refractive /Cataract /Cornea Workshop (Auditorium C) Prof. Hani Al-Mezaine 13:30 - 14:30 Lasers and Lenses: Emerging Cataract Technology Stephen McLeod, MD 15:20 - 15:45 Break M4A 3rd Ophthalmic Techical Seminar (Auditorium A) 15:45 - 16:15 Neuro Visual Field Defects with Goldman Perimetry Helmieh Fayad, COMT M4B Moderator Neuro Ophthalmology (Auditorium B) Maha Bader, MD 15:45 - 16:15 17:15 - 17:30 Ptosis Fion Domnall Bremner, MD Anisocoria Fion Domnall Bremner, MD Botulinum Toxin Fion Domnall Bremner, MD Discussion M4C Chair Moderator Uveitic Glaucoma Workshop (Auditorium C) Hassan Al-Dhibi, MD Sami Al-Shahwan, MD 15:45 - 17:30 Uveitic Glaucoma Management Hassan A Al-Dhibi, MD; Sami Al-Shahwan, MD; Ibrahim Al-Jadaan, MD; Deepak Edward, MD; Sameer Ahmad, MD; Rizwan Malik, MD; Saleh Al-Obeidan, MD; Essam Osman, MD; Faisal Al-Mobarak, MD 16:15 - 16:45 16:45 - 17:15 16 Saudi Ophthalmology 2016: Program and Abstracts Tuesday, March 8 T1A Chair Moderator Cornea Session (Auditorium A) Prof. Mubarak Al Faran Hafez Al Faleh, MD 08:00 - 08:15 09:15 - 09:30 Epidemiology of Herpes Simplex Eye Disease in an Urban Population David C. Gritz, MD New Paradigms in the Treatment of Fungal Keratitis Elmer Tu, MD Tobacco Smoking and Sjogren Syndrome - A Complicated Relationship Donald Stone, MD Ocular Pathogens and Antibiotic Sensitivity in Bacterial Keratitis Isolates at King Khaled Eye Specialist Hospital 2011-2014 Huda Saif Al-Dhaheri, MD Update on The Management of Parasitic Keratitis Elmer Tu, MD Discussion 09:30 - 09:45 Break T1B Chair Moderator Neuro Ophthalmology (Auditorium B) Samira Awaji, MD Lama Enani, MD 08:00 - 08:25 Ocular Motor Palsies Fion Domnall Bremner, MD Painful Ophthalmoplegia Fion Domnall Bremner, MD Myasthenia Gravis Fion Domnall Bremner, MD Acupuncture Treatment in Patients with Optic Neuropathy Md. Anwarul Azim, MD 08:15 - 08:30 08:30 - 08:45 08:45 - 09:00 09:00 - 09:15 08:25 - 08:50 08:50 - 09:15 09:15 - 09:30 T1C Chair Moderator Retina (Auditorium C) Igor Kozak, MD Abdulelah Abdullah, MD 08:00 - 08:20 Visual Cycle Modulation in Central Serous Retinopathy Rajendra Apte, MD, PhD High Mobility Group Box-1 Regulates The Expression of Matrix Metalloproteinase-9 in Diabetic Retina Mohammad Ghulam, PhD Vitreous Levels of Placental Growth Factor Correlates with Activity of Proliferative Diabetic Retinopathy and Is Not Influenced by Bevacizumab Treatment Eman Al-Khatani, MD The Chemokine Platelet Factor-4 Variant (PF-4var) CXCL4L1 Inhibits Diabetes-induced Blood Retinal Barrier Breakdown Ahmed Abu El-Asrar, MD, PhD 08:20 - 08:30 08:30 - 08:40 08:40 - 08:50 Saudi Ophthalmology 2016: Program and Abstracts 17 08:50 - 09:10 09:20 - 09:30 Seeing Through VEGF: Inflammation and Angiogenesis in Retinal Vascular Disease Rajendra Apte, MD, PhD Serum Molecular Signature for Proliferative Diabetic Retinopathy in Saudi Patients with Type 2 Diabetes Eman Al-Khatani, MD Discussion T2A Chair Moderator Cataract Session (Auditorium A) Sabah Jastanieh, MD Abdullah Al-Fawaz, MD 09:45 - 10:00 10:45 - 11:00 Toric IOLs in Patients with Previous Corneal Refractive Surgery and Ectasias Enrique J. Suarez, MD Capsule Challenges Stephen McLeod, MD Impact of Axial Length and Preoperative Intraocular Pressure on Postoperative Intraocular Changes in Non-glaucomatous Eyes Following Phacoemulsification in a University Hospital, Riyadh, Saudi Arabia Noor M. Al Anazi, MD Management of The Small Pupil Stephen McLeod, MD Discussion T2B Chair Moderator Pediatric Ophthalmology (Auditorium B) Abdullah Al-Otaibi, MD Mohammed Al-Shamrani, MD 09:45 - 10:00 Refractive Errors in Pediatric: Solutions and Challenges Ismael Al-Ghamdi, MD Surgical Tips in Strabismus Surgery Evylene Paysse, MD Anatomic Indices following Photorefractive Keratectomy in Children 5+ Years after Surgery Evylene Paysse, MD Secondary Implantation of Implantable Collamer Lens (ICL) for Correction of Anisometropic Hyperopia in A 3-year-old Pseudophakic Child Saad Al-Thiabi, MD Practical Guide to Refractive Surgery Evylene Paysse, MD 09:10 - 09:20 10:00 - 10:15 10:15 - 10:30 10:30 - 10:45 10:00 - 10:20 10:20 - 10:35 10:35 - 10:45 10:45 - 11:00 T2C Chair Moderator Neuro Ophthalmology (Auditorium C) Majed Al-Obailan, MD Danya Al-Showair, MD 09:45 - 10:15 Chronic Progressive External Ophthalmoplegia Patrick YU WAI MAN, MD Treatment Strategies for Inherited Neurodegenerative Disorders Patrick YU WAI MAN, MD Clinical Variability in Wolfram syndrome Alberto Galvez, MD Discussion 10:15 - 10:45 10:45 - 11:00 11:00 - 11:15 18 Saudi Ophthalmology 2016: Program and Abstracts Saudi Ophthalmological Gold Medal Lecture (Auditorium B) Chair Moderator Abdullah Al-Otaibi, MD Ali Al-Halafi, MD 11:00 - 11:05 Introduction of Dr. Stephen Russull Ali Al-Halafi, MD Gene Therapy Results from The RPE65 Phase 3 Trial for Lebers Congenital Amaurosis Stephen Russell, MD 11:05 - 12:00 12:00 - 12:30 Lunch Break & Prayer 12:30 - 13:45 Opening Ceremony (Auditorium A) T3A Chair Moderator Neuro Ophthalmology (Auditorium A) Maha Bader, MD Lama Enani, MD 13:45 - 14:15 15:15 - 15:20 Optic Neuritis Fion Domnall Bremner, MD Papilloedema Fion Domnall Bremner, MD Giant Cell Arteritis Fion Domnall Bremner, MD Discussion T3B Chair Moderator Prevention of Blindness (Auditorium B) Saad Hajer, MD Khalid Al-Arfaj, MD 13:45 - 13:50 Introduction of Dr Babar Qureshi Khaled Al-Arfaj, MD POB Shield Lecture: Changing Trends in Ophthalmic Medical Education Khaled Al-Arfaj, MD Validity and Usefulness of ‘RETEVAL’ a Hand-held Electro-physiological Tool in Diabetic Retinopathy Screening Compared to Conventional Digital Fundus Photography Khaled Al-Arfaj, MD Neglected Tropical Diseases and Eye Health Muhammad Babar Qureshi, MD Risk of Glaucoma in Obstructive Sleep Apnea Patients in King Abdulaziz University Hospital Alberto Galvez, MD Developing Eye Care Teams Muhammad Babar Qureshi, MD Uncorrected Refractive Errors, How Do We Address It Muhammad Babar Qureshi, MD Control of Diabetic Retinopathy in Health Systems Muhammad Babar Qureshi, MD 14:15 - 14:45 14:45 - 15:15 13:50 - 14:20 14:20 - 14:30 14:30 - 14:45 14:45 - 14:55 14:55 - 15:10 15:10 - 15:20 15:20 - 15:30 Saudi Ophthalmology 2016: Program and Abstracts 19 T3C Chair Moderator Optometry - Low Vision (Auditorium C) Prof. Alan Johnston Khalid Jamous, MOptom, PhD 13:45 - 14:05 15:05 - 15:20 Low Vision - Identifying Disability and Rehabilitation Need from Clinical Diagnosis Khalid Jamous, MOptom, PhD The Log MAR Visual Acuity Calculator - Making Certain Decisions for The Prescription of Magnification Prof. Alan Johnston The Simple Magnifier - Maximising The Interaction between Image Enlargement and Field of View Prof. Alan Johnston The Low Vision Telescope - An Underused but Highly Effective Device for Distance and Intermediate Visual Tasks Prof. Alan Johnston Discussion 15:20 - 15:45 Break T4A Chair Moderator Cataract Session (Auditorium A) Ali Al-Rajhi, MD Maan Al-Barry, MD 15:45 - 16:00 Posterior Polar Cataract Stephen McLeod, MD Assessment of Learning Curve in Phacoemulsification Surgery among Eastern Province Ophthalmology Program Residents Abdullah Abdulrahman Al-Marshood, MD Lens Calculations after Refractive Surgery Stephen McLeod, MD Utility of VERUS Ring in Performing Safe and Efficient Capsulorhexis with Corneal Scarring Enrique J. Suarez, MD Comparison between Digital and Manual Marking for Toric Intraocular Lenses Hany Ahmed Helaly, MD Management of Loose Zonules Stephen McLeod, MD Discussion 14:05 - 14:25 14:25 - 14:45 14:45 - 15:05 16:00 - 16:15 16:15 - 16:30 16:30 - 16:45 16:45 - 17:00 17:00 - 17:15 17:15 - 17:30 T4B Prevention of Blindness (Auditorium B) Seminar, Rights of Blind and Low Vision in Saudi Arabia T4C Chair Moderator Pediatric Ophthalmology (Auditorium C) Ismael Al-Ghamdi, MD Saif Al-Obaisi, MD 15:45 - 16:05 New Surgical Procedures for Incomitant Strabismus Evylene Paysse, MD In Situ Dissection for Topical Adjustable Strabismus Surgery David Coats, MD New Surgical Approaches for Nystagmus Evylene Paysse, MD True Micro-Incisional Strabismus Surgery Using the Coats Double Ended Curved Hook David Coats, MD ET go home Evylene Paysse, MD Discussion 16:05 - 16:30 16:30 - 16:50 16:50 - 17:05 17:05 - 17:15 17:15 - 17:30 20 Saudi Ophthalmology 2016: Program and Abstracts Wednesday, March 9 W1A Chair Moderator Cornea Session (Auditorium A) Samar Al-Swailem, MD Khaled Al-Arfaj, MD 08:00 - 08:15 09:15 - 09:30 The Challenge of Herpetic Viral Keratitis Elmer Tu, MD Clinical Results of a Foldable Artificial Cornea – Personal Experience Jose Manuel Vargas, MD The Unique Role of Confocal Microscopy in the Diagnosis of Corneal Disease Elmer Tu, MD Corneal Myxoma Presentation and Management - A Case Series Bader Saad Al-Qahtani, MD Safety of Long-term Treatment with Topical Tacrolimus 0.01% Eye Drops Samir Shawki Shoughy, MD The Diagnosis and Management of Ocular Surface Tumors Elmer Tu, MD Discussion W1B Chair Moderator Neuro Ophthalmology (Auditorium B) Alberto Galvez, MD Danya Al-Showair, MD 15:40 - 16:05 17:20 - 17:30 Neuromyelitis Optica Patrick YU WAI MAN, MD Traumatic Optic Neuropathy Patrick YU WAI MAN, MD Congenital Optic Disc Abnormalities Patrick YU WAI MAN, MD Non-glaucomatous Optic Neuropathy Patrick YU WAI MAN, MD Discussion W1C Chair Moderator Optometry - The Role of Optometrists in The Delivery of Eye Health Care (Auditorium C) Prof. Michael Kalloniatis Lina Al-Kahmous, Senior Orthoptist, MSc of Canadian Certified Orthoptist 08:00 - 08:15 09:15 - 09:30 The Need for Eye Care Prof. Michael Kalloniatis Models Integrating Optometrists in Eye Health Delivery Prof. Michael Kalloniatis The Short-sighted Perspective of Long-term Eye Health Care Reem Al-Qhahtani Evidence-based Approach to Improving Optometrist Contribution to Eye Health Care Importance of Education Prof. Michael Kalloniatis The Future of Eye Health Care Prof. Michael Kalloniatis Discussion 09:30 - 09:45 Break 08:15 - 08:25 08:25 - 08:40 08:40 - 08:50 08:50 - 09:00 09:00 - 09:15 16:05 - 16:30 16:30 - 16:55 16:55 - 17:20 08:15 - 08:30 08:30 - 08:45 08:45 - 09:00 09:00 - 09:15 Saudi Ophthalmology 2016: Program and Abstracts 21 W2A Chair Moderator Retina (Auditorium A) Sawsan Nowilaty, MD Fadwa Al Adel, MD, FRCSC 09:45 - 10:05 10:45 - 11:00 Automated Detection of Diabetic Retinopathy and The Need for Telescreening Stephen Russell, MD Congenital Stationary Night Blindness with Defective Signal Transmission at The Level of the Bipolar Cells Patrick Schatz, MD Methods and Surgical Technique for Gene and Cell-Based Retinal Therapies Stephen Russell, MD Coats’- like Retinopathy in Joubert Syndrome Salwa Khider Al-Shibani, MD Discussion W2B Chair Moderator Pediatric Ophthalmology (Auditorium B) Shahira Turkmani, MD Elham Al-Qahtani, MD 09:45 - 10:00 Visual Acuity Assessment in Amblyopic Children Amal Al-Humaidan, MD PEDIG: Overview Omar Basamh, MD Compliance with Amblyopia Treatment Ahmed Al-Yahya, MD My Amblyopia Treatment Is Not Working: What Am I Doing Wrong? David Coats, MD Amblyopia Treatment: What’s New? Amal Al-Humaidan, MD 10:05 - 10:15 10:15 - 10:35 10:35 - 10:45 10:00 - 10:20 10:20 - 10:30 10:30 - 10:45 10:45 - 11:00 King Khaled Memorial Lecture (Auditorium B) Chair Abdulelah Al-Towerki, MD Moderator Mohammed Al-Shamrani, MD 11:00 - 11:05 11:05 - 12:00 Introduction of Dr. Evylene Paysse Mohammed Al-Shamrani, MD Refractive Surgery in Children Evylene Paysse, MD 12:00 - 12:30 Poster & Video Award 12:00 - 12:15 Lunch Break & Prayer 12:15 - 13:00 SOS General Assembly (Auditorium B) W3A Chair Moderator Refractive Surgery Session (Auditorium A) Abdulrahman Al-Moammer, MD Salem Al-Malki, MD 13:00 - 13:20 Outcome of Intrastromal Corneal Ring (INTACS SK) Using Femtosecond Laser In Keratoconus Patients (KKESH Experience) Awad Ali Al-Qarni, MD 22 Saudi Ophthalmology 2016: Program and Abstracts 13:20 - 13:35 14:25 - 15:00 Correlation between Practice Location as a Surrogate for UV Exposure and Practice Patterns to Prevent Corneal Haze after Photorefractive Keratectomy (PRK) Eman Al-Sharif, MD I-year Follow Up of Implantable Collamer Lens (ICL) Anismetropic Amblyopia of Children Amr Said Radwan, MD Management of Perforation in LKP, Review and Report of Unusual Complication Awad Ali Al-Qarni, MD Herpetic Keratitis after Cross-linking for Keratoconus Awad Ali Al-Qarni, MD Discussion W3B Chair Moderator Pediatric Ophthalmology (Auditorium B) Saleh Al-Mesfer, MD Amal Al-Humidan, MD 13:00 - 13:15 14:30 - 15:15 Acquired Non-accommodative Esotropia: When to Worry? Evylene Paysse, MD Complications of Strabismus Surgery in Adults David Coats, MD New Technique for Squint Surgery Said Abdulkader Jamal eddin, MD Small incision Strabismus Surgery using the Paysse Hook Evylene Paysse, MD Double Vision: The Patient Experience David Coats, MD The Profile of Pediatric Ophthalmic Emergency Cases Presented to King Abdulaziz University Hospital’s Emergency Department in Riyadh, Saudi Arabia: A Six-month Retrospective Study Abdulrahman Abdulaziz Al-Jasser, MD Discussion W3C Chair Moderator Retina (Auditorium C) Saad Al-Dahmash, MD Abdullah Al-Mousa, MD 13:00 - 13:20 The Lost Art of Retinal Drawing Stephen Russell, MD Precision in Vitreoretinal Surgery, Manual versus Assisted Instrument Positioning Marco Mura, MD Surgical Management of Diabetic Retinopathy Rajendra Apte, MD, PhD Predicting Factors for Visual Acuity Outcomes following Surgery for Epiretinal Membranes Ali Al-Halafi, MD A New Complication of Cataract Surgery: Hemorrhagic Occlusive Retinal Vasculitis Stephen Russell, MD Role of Intravitreal Bevacizumab As Adjunctive Therapy in Retinopathy of Prematurity Khalid Al-Husseiny, MD Scleral Buckling Using Wide Angled Chandelier Illumination as an Educational Tool Rajendra Apte, MD, PhD Controversies in Management of Dislocated IOLs Stephen Russell, MD Discussion 13:35 - 13:50 13:50 - 14:10 14:10 - 14:25 13:15 - 13:40 13:40 - 13:50 13:50 - 14:00 14:00 - 14:20 14:20 - 14:30 13:20 - 13:30 13:30 - 13:50 13:50 - 14:00 14:00 - 14:10 14:10 - 14:20 14:20 - 14:40 14:40 - 15:00 15:00 - 15:15 Saudi Ophthalmology 2016: Program and Abstracts 23 W4A Chair Moderator Cornea Workshop (Auditorium A) Othman Al-Omar, MD Abdullah Assiri, MD 15:40 - 17:30 Keratoconus Management: Stepwise Approach Maan Al-Barry, MD - Majed Al-Kharashi, MD - Sabah Jastaniah, MD - Abdullah Assiri, MD W4C Chair Moderator Retina (Auditorium C) Ahmed Abu El-Asrar, MD, PhD Abdullah Al-Kharashi, MD, FRCS 15:40 - 16:00 Positional and Other Dynamic Changes on Optical Coherence Tomography Stephen Russell, MD Retinal Degeneration 2016 Rajendra Apte, MD, PhD Use of New Intraocular Spectral Domain Optical Coherence Tomography in Vitreoretinal Surgery Marco Mura, MD Correlation between Microperimetry and Optical Cohernce Tomography in Macular Edema Secondary to Acute Retinal Vein Occlusuon Before and After Bevacizumab Injection Turki Abdulaziz Bin Dakhil, MD Presumed Intraocular Tuberculous Uveitis in Tertiary Hospital in Riyadh Awad Al-Qarni, MD Indocyanine Green Angiographic Findings in Initial-onset Acute Vogt-Koyanagi-Harada Disease Marwan Abouammoh, MD Myofibroblasts in Proliferative Diabetic Retinopathy Can Originate from Infiltrating Fibrocystes and Through Endothelial-to-mesenchymal Transition (EndoMT) Ahmed Abu El-Asrar, MD, PhD Discussion 16:00 - 16:20 16:20 - 16:30 16:30 - 16:40 16:40 - 16:50 16:50 - 17:00 17:00 - 17:10 17:10 - 17:30 24 Saudi Ophthalmology 2016: Program and Abstracts Thursday, March 10 Th1A Chair Moderator Free Paper (Auditorium A) Prof. Adel Al Suhaibani, MD Alicia Galindo, MD, PhD 08:00 - 08:10 09:50 - 10:00 Troubles from Trichomegaly of the Eyelashes: A Case Report of Erlotinib Induced Trichomegaly Mohammed yusuf Hasambhai Shaikh, MD Blow In Orbital Fracture in Endoscopic Turbinate Surgery Alicia Galindo Ferreiro, MD, PhD Tuberculous Conjunctivitis in an Anophthalmic Socket Omar Abdulsalam, MD Frontalis Sling Silicone Rode Open Crease vs Closed Stab Technique to Correct Severe Ptosis with Poor Levator Function Alicia Galindo Ferreiro, MD, PhD Blind Painful Eyes: What to Inject? Comparative Study of Retrobulbar Injection of Ethanol versus Chlorpromazine Alicia Galindo Ferreiro, MD, PhD Orbital Lymphoma Behaves as Subperiosteal Mass Abdulrahman Faisal Al-Bloushi, MD Localized Orbital Amyloidosis: Case Report Laila Salem Al-Ghaferi, MD Skin Wrapped Conformer over a Temporalis Muscle Transfer to Reconstruct Severely Contracted Socket Omar BenHusain, MD Eye Diseases Due to/and Treated by Hyperbaric Oxygen Therapy Medhat Mohamed Eldakhakhny, MD Perceptions and Career Expectation in Ophthalmology among Saudi Undergraduate Medical Students Majid Bahaa Abalkhail, MD Assessment of Awareness of Patients’ Rights and Attitude toward Ophthalmology Residents in University of Dammam (Ophthalmology Department) Abdulaziz Hamdan Al-Dhafeeri, MD Discussion Th1B Chair Moderator Retina (Auditorium B) Saba Al-Rashaed, MD Yahya Al-Zahrani, MD 08:00 - 08:12 Upregulated Expression of Heparanase in the Vitreous of Patients with Proliferative Diabetic Retinopathy Originates from Activated Endothelial Cells and Leukocystes Ahmed Abu El-Asrar, MD, PhD Diabetic Retinopathy: Knowledge, Awareness and Practices of Physicians in Primary-Care Centers in Riyadh, Saudi Arabia Raghad Al-Rasheed, MD Atypical Finding of Idiopathic Macular Telangiectasia Type 2 with Peripheral Vascular Anomaly Saba Al-Rashaed, MD Purtscher-like Retinopathy as a First Manifestation of Systemic Lupus Erythematosus Reem Al-Ahmadi, MD Rare Presentation of Dome-Shaped Maculain Saudi Patient Adel Al-Akeely, MD 08:00 - 08:20 08:20 - 08:30 08:30 - 08:40 08:40 - 08:50 08:50 - 09:00 09:00 - 09:10 09:10 - 09:20 09:20 - 09:30 09:30 - 09:40 09:40 - 09:50 08:12 - 08:24 08:24 - 08:36 08:36 - 08:48 08:48 - 09:00 Saudi Ophthalmology 2016: Program and Abstracts 25 09:00 - 09:12 09:48 - 10:00 Ocular Injuries Secondary to Alexandrite Laser-Assisted Hair Removal Mohammed Asiri, MD T-shaped Macula Buckling Combined with Pars Plana Vitrectomy for Macular Hole, Macular Schisis and Macular Detachment Marco Mura, MD Retinopathy of Prematurity (ROP) Prevalence and Risk Factors in King Abdulaziz Medical City (KAMC) in Riyadh Bader Al-Qahtani, MD Incidence of Retinal Detachment in Patients with Bechet’s Disease Samir Shawki Shoughy, MD Discussion Th1C Moderator 3rd Ophthalmic Technical Seminar (Auditorium C) Shaban Shaban, COT 08:00 - 08:30 Recognizing and Handling Unusual Contact Lens Problems Dr. William Ehlers Contact Lens Fitting in Infants Mohammed Al Blowi Overview of Ocular Electrophysiology Nayef Al-Ateeq Latest Technology in Electrophysiology Mr. Craig Simms 09:12 - 09:24 09:24 - 09:36 09:36 - 09:48 08:30 - 08:50 08:50 - 09:20 09:20 - 10:00 10:00 - 10:20 Break Th2A Chair Moderator Free Paper (Auditorium A) Deepak Edward, MD Prof. Essam Osman, MD 10:20 - 10:30 Safety and Efficacy Comparison between Brand-name and Localy Manufactured Generic Fixed Combination of 2% Dorzolamide/0.5% Timolol Leyla A Ali Al-Jasim, MD Elevated Intraocular Pressure Increases Melatonin Levels in the Aqueous Humour Hanan Awad Al-Kozi, MD Bottle Characteristics of Topical International Glaucoma Medications versus Local Brands in Saudi Arabia Reham Dakam Al-Qahtani, MD Histopathologic and Immunohistochemical Features of Capsular Tissue around Failed Ahmed Glaucoma Valves Alka M Mahale, PhD Ocular Side Effects of Topical Prostaglandins in Childhood Glaucoma Edward Deepak, MD Diagnostic Accuracy of Spectral Domain Optical Coherence Tomography and Scanning Laser Tomography for Identifying Glaucoma in Myopic Eyes Rizwan Malik, MD Ergonomic in Preventing Work Related Musculoskeletal Disorders in Ophthalmic Practice Waleed Abdulaziz Al-Rashed, MD Genetics of Congenital Glaucoma in Saudi Arabia, Phenotype-Genotype Correlation Leen Jameel Abu Safieh, PhD Discussion 10:30 - 10:40 10:40 - 10:50 10:50 - 11:00 11:00 - 11:10 11:10 - 11:20 11:20 - 11:30 11:30 - 11:40 11:40 - 12:00 26 Saudi Ophthalmology 2016: Program and Abstracts Th2B Moderator Optometry - Color vision (Auditorium A) Lina Al-Kahmous, Senior Orthoptist, MSc of Canadian certified orthoptist 10:20 - 10:40 11:40 - 11:55 Color Vision Processing in the Visual System: Retina to Cortex Prof. Michael Kalloniatis Color Vision Testing Prof. Michael Kalloniatis Congenital and Acquired Color Vision Deficiencies Prof. Michael Kalloniatis Giving Practical Advice Relating to Color Vision Results Prof. Michael Kalloniatis Discussion Th2C Moderator 3rd Ophthalmic Technical Seminar (Auditorium C) Ahmad Al-Ghamdi, COMT 10:20 - 10:50 Introduction to Anaplastology Mohammed Badran Imaging of the Posterior Segment of the Eye Igor Kozak, MD Diagnostic Ultrasound Mr. Craig Simms 10:40 - 11:00 11:00 - 11:20 11:20 - 11:40 10:50 - 11:20 11:20 - 12:00 12:00 - 13:00 Lunch Th3A 13:00 - 15:00 Comprehensive B-Scan Ultrasound Course (Auditorium A) Instructors: Raja Hariz, Chief Ultrasound and Talal Al Anazi, Optometrist Th3B 13:00 - 15:00 Optometry Workshop ( Auditorium B) Low Vision Workshop Prof. Alan Johnston and Khalid Jamous, MOptom, PhD Th3C Moderator 3rd Ophthalmic Technical Seminar (Auditorium C) Salah Al-Megrin, COMT 13:00 - 13:30 Ophthalmic Ultrasound in Ocular Trauma Mr. Craig Simms Fluorescein Angiography Abdulrahman Al-Oraini Ocular Topography Workshop 13:30 - 13:45 13:45 -15:00 Saudi Ophthalmology 2016: Program and Abstracts 27 Poster Presentations 1. Fungal Sclerokeratitis Salem Al-Malki, MD; Abdulrahman Gormallah Al-Malki, MBBS 2. Post BKpro Endophthalmitis in Steven Johnson Syndrome Patient due to Streptococcus Agalacticae Donald Stone, MD; Igor Kozak, MD; Omar Kirat, MD; Mohammad Ahmed Talea, MD; Humoud Mohammad Al-Otaibi, MBBS 3. Genetics of Congenital Glaucoma in Saudi Arabia, Phenotype-Genotype Correlation Leen Jameel Abu Safieh, PhD; Leyla Al Jasim, MD; Ohood Owaydha, MD; Deepak Edward, MD 4. Combined Central Retinal Artery Occlusion with Central Retinal Vein Occlusion after Blunt Trauma Mohammad Abdullah Al-Amry, MD; Hassan Al-Dhibi, MD; Sahar M ElKhamary, MD; Abdulrahman Al-Qaeed 5. Signal Transducer and Activator of Transcription 3 Expression is Regulated by High-Mobility Group Box-1 Protein in Diabetic Retina Deema Essam Jomar, MBBS; Ghulam Mohammad, MD; Ahmed M. Abu El-Asrar, MD, PhD 6. Late Onset Endophthalmitis Associated with Unexposed Glaucoma Valve Drainage Device Abdulaziz Mohammad Al-Hadlaq, MD 7. Atypical Presentation of Cone-rod Dystrophy with Huge Bull’s Eye Maculopathy and Diffuse Vascular Leakage Hamad Mohammad Alsulaiman, MD; Sawsan R Nowilaty, MD; Patrik S. Schatz, MD 8. Retinal Complications after Anterior versus Posterior Chamber Phakic Intraocular Lens Implantation in a Myopic Cohort Abdulelah Abdulaziz Al-Abdullah, MD; Mohammad A. Al-Falah, MD; Saba A. Al-Rasheed, MD; Rajiv Khandekar, MD; Enrique Suarez, MD; J. Fernando Arevalo, MD 9. Acupuncture Treatment in Patients with Retinitis Pigmentosa, Tapetoretinalabiotrophy and Macular Dystrophy Md Anwarul Azim, MD; Kuznetsova TS, MD 10. Effect of Vitamin Deficiency and Insufficiency on Patient with Diabetic Retinopathy Amjaad Hamad Al-Mohawis; Moutaz GUMA; Ahoud Al-Mutairi; Ghada Al-Duraye 11. Choroidal Thickness in Hypertensive Patients and Healthy Controls Hanan Abdullah Al-Shalan, MD; Faisal Abdulaziz AlMobarak, MD 12. Immunohistochemical Characterization of Subretinal Bands in Proliferative Vitreoretinopathy Mohammed D. Al-Otaib, MBBS; Azza Maktabi, MD; Hind Al-Katan, MD; Deepak Edward, MD; Igor Kozak, MD 13. Chiasmal Optic Neuritis Abdulaziz Mohammad Al-Hadlaq, MD; Aliyah Hadi Al-Amery, MBBS; Alberto Galvez, MD 28 Saudi Ophthalmology 2016: Program and Abstracts 14. Duane Retraction Syndrome Associated with a Small X Chromosome Deletion Taif A. Azad, MSc; Khaled K. Abu-Amero, PhD; Altaf Kondkar, PhD; Hessa Al-Odan, MD; Arif Khan, MD; Darren T. Oystreck, MMed Sci; Ali M. Hellani, PhD; Thomas M. Bosley, MD 15. Pattern of Neuro Ophthalmic Cases Presented to King Abdulaziz University Hospital’s Emergency Department in Riyadh, Saudi Arabia: A Two-year Retrospective Study Abdulrahman Abdulaziz Al-Jasser, MD; Majed Mohammad Al-Obailan, MD; Yafa Abdulrahman Al-Shamlan, MBBS; Lolwah Mohammed Alashgar, MBBS; Norah Ahmed Musallam, MBBS; Ahmed Mousa Abdul Rahim, MBBS 16. Anophthalmic Chronic Inflammation due to RTV Orbital Implant Silvana Schellini, MD; Alicia Galindo-Ferreiro, MD; Laila Al-Ghafri, MD; Sahar ElKhamary, MD; Azza Maktabi, MD 17. Outcomes of Two Surgical Techniques for Major Trichiasis Silvana Artioli Schellini, MD; Lucieni Barbarini Ferraz, MD; Roberta Lilian Fernandes de Sousa Meneguim, MD; Alicia Galindo-Ferreiro, MD; Ana Cláudia Viana Wanzeler, MD; Michelli Massae Saruwatari; Larissa Horikawa Satto; Carlos Roberto Padovani 18. Analysis of Toll-like Receptor rs4986790 Polymorphism in Saudi Patients with POAG Mohammad Taif Anwar Azad, MD; Saleh A. Al-Obeidan, MD; Altaf A. Kondkar, MD; Ahmed Mousa, MD; Tahira Sultan, MD; Essam A. Osman, MD; Khaled K. Abu-Amero, PhD 19. Congenital Hemifacial Hypertrophy and Glaucoma Reham Dakam Al-Qahtani, MBBS; Halla Al Abdul-Hadi, MBBS; Ahmed Al-Habash, MD; Sami Al-Shahwan, MD 20. Paintball Ocular Injury Mohammad Al-Amry, MD; Nora Abdulmohsen Al-Yousif, MBBS; Halla Al-Abdulhadi; MBBS; Huda A Al-Ghadeer, MD 21. Compliance of Glaucoma Patients to Ocular Hypertensive Medications among the Saudi Population Priscilla Wairimu Gikandi 22. Severe Bilateral Episcleritis after Incidental Trauma by Eye Lashes Serum Mohammad Al-Amry, MD; Halla Ahmed Al-Abdulhadi, MD; Nora Abdulmohsen Al-Yousif; Saleh Al-Othaimeen, MD 23. Congenital Ptosis, Scoliosis and Malignant Hyperthermia Susceptibility in Siblings with Recessive RYR1 Mutations Amani Saeed Al-Bakri, MD Saudi Ophthalmology 2016: Program and Abstracts 29 Video Presentations 1. Double Layer AMT for Conjunctival Reconstruction after Recurrent Squamous Cell Carcinoma Hernan M Osorio, MD 2. Surgical Treatment of Conjunctival MALT L ymphoma Hernan M Osorio, MD 3. Corneal Subepithelial Hemorrhage: Diagnosis and Management Salman Abumazyad, MD 4. The Management of Black Cataract with Pseudoexfoliation (PXF) and Phacodonesis in Small Pupil Saeed Al-Gehedan, MD 5. Challenging Cataract Surgery in Case of Corneal Cystinosis Saeed Al-Gehedan, MD 6. Cataract Management in Marfan’s Syndrome: Techniques and Outcomes Saeed Al-Gehedan, MD 7. Management of Subluxated Lens Saad Saleh Al-Harbi, MD 8. Lessons from White Cataract Abdulelah Abdulaziz Al-Abdullah 9. New Technique to Overcome Difficult Posterior Vitreous Detachment Mohammed Salem Asiri, MD 10. Spontaneous Internal Limiting Membrane Detachment Mistaken as a Retinal Detachment Mohammed Salem Asiri, MD 11. Surgical Procedure of Implanting Argus II Retinal Prosthesis System Eman Saeed Al-Kahtani, MD 12. Rhegamtogenous Retinal Detachment in Immunocompromised Patient with PORN Secondary to CMV Infection Eman Saeed Al-Kahtani, MD 13. Funnel Shape Retinal Detachment: It Is Not Operable!! “My Fellow Said” Abdulelah Abdulaziz Al-Abdullah, MD 14. Replacement of Phakic IOL: Techniques and Outcomes Saeed Al-Gehedan, MD 30 Saudi Ophthalmology 2016: Program and Abstracts Abstracts Monday, March 7 M2B - Pediatric Ophthalmology Workshop Pediatric IOL Implantation Mohammed AlShamrani Purpose: T explore variable methods of optical correction in pediatric population. Course Goals and Objectives: 1) Aphakia and aphakic correction other than IOL (contact lenses and glasses: pros and cons); 2) Why not to implant IOL in children; 3) History of IOL implantation in pediatric; 4) Issues related to IOL calculation in pediatric and power selection; 5) Secondary IOL implantation in pediatric; 6) Lens based refractive surgery in pediatric (clear lens extraction, phakic IOLs); 7) Challenging cases (video or cases discussion). Target Audience: Ophthalmologist and optometrist. Education Level: Bachelor degree in medicine and optometry. M2C - Optometry - Contact Lenses Post-Penetrating Keratoplasty Hard Contact Lenses Fitting Muneera Al-Ogla Hard contact lenses fitting can be quite challenging after Penetrating Keratoplasty but with the tips given, associated with explanation of some of the corneal topography classifications with an example image of each, one can give general idea of what is acceptable fitting and what is not. M3B - Optometry - Orthopic & Free Paper A and V Patterns Heba Khashoggi A and V patterns are common terminologies that are used when the size of Eso/Exo deviation significantly changes as the eyes move from up gaze to down gaze. This presentation will discuss the classification, etiology and management of each pattern. A Comparison of EFG Therapy vs Patching for The Treatment of Amblyopia in Children Aged 9-17 Years Manal Al-Harbi To compare the effectiveness of Eyetronix flicker glasses (EFG) therapy and patching for improving distance vision acuity and stereopsis in children 9 to 17 years of age with strabismic or anisometropic amblyopia. Orthoptic Role in Bilateral 6th Nerve Palsy Zainab Al-Khodairi Highlighting the role of the orthoptist in diagnosing and being involved non-surgically in the initial management of ocular motor palsies. The purpose of the treatment is to improve patient comfort and visual function by eliminating diplopia and helping the patient to regain his binocular single vision and be able to practice every day activity normally. Saudi Ophthalmology 2016: Program and Abstracts 31 Tuesday, March 8 T1A – Cornea Session Epidemiology of Herpes Simplex Eye Disease in an Urban Population David C. Gritz Purpose: To determine whether HIV/AIDS, diabetes mellitus, and atopic disease are associated with herpes simplex virus (HSV) eye disease, and to examine the characteristics of HIV-positive patients with HSV eye disease. Methods: This retrospective case-control study compared cases (inclusion criteria: a diagnosis of HSV eye disease by an ophthalmologist and residency in the Bronx) with a medical center outpatient-based control group (attending an outpatient clinic and residency in the Bronx). The study period was June 1, 2010 through May 31, 2014 and included all outpatient visits within the Montefiore Medical Center healthcare system (Bronx, NY, USA). Ratio of cases to controls was 1:4. Associations evaluated included age, gender, HIV/AIDS, diabetes mellitus, and atopic disease. Results: HSV eye disease was confirmed in 70 patients, who were compared to 280 controls. Patients with ocular HSV had a greater prevalence of HIV/AIDS compared to controls (8.6% and 2.9%, respectively). Using multivariate analysis to control for age and gender, atopic dermatitis (OR 3.08, 95% CI: 0.84 to 11.20) and diabetes with chronic complications (OR 2.25, 95% CI: 0.91 to 5.61) approached significance, while HIV/AIDS (OR 3.37, 95% CI: 1.09 to 10.40), an age less than 45 years (OR 2.89, 95% CI: 1.54-5.41), and male gender (OR 1.85, 95% CI: 1.07 to 3.18) were significant. Among the HIV-positive group of HSV eye disease patients, 5 of 6 (83.3%) were on HAART therapy and all 6 (100%) presented with a form of keratitis or retinitis. Conclusions: HIV-positive status results in more than a three-fold increased risk of developing ocular HSV. To our knowledge, this study represents the first time strength of association has been calculated between HIV and HSV eye disease. New Paradigms in The Treatment of Fungal Keratitis Elmer Tu Fungal keratitis remains one of the most challenging corneal infections to diagnose and treat successfully. The outcomes of fungal keratitis are significantly worse than those for bacterial keratitis with both a higher likelihood of significant visual loss as well as a need for therapeutic surgical intervention. The number of anti-fungals, commercial and compounded, is limited in comparison to anti-bacterial drugs with generally poorer tissue penetration and a narrower anti-fungal spectrum. Clinical signs and symptoms can be helpful in suspecting potential cases of fungal keratitis, but definitive diagnosis requires microbiologic testing and corneal imaging. Although polyenes, amphotericin B and natamycin, continue to be mainstays of therapy, the most significant development is the introduction of the newer triazoles, voriconazole and posaconazole, as well as the new echinocandin class of anti-fungals, micafungin, caspofungin and anidulafungin. These newer agents not only offer a wider spectrum of activity and better tissue penetration, but also new routes of administration to achieve cure of ocular infections including oral, topical, intracameral and intrastromal. Tobacco Smoking and Sjogren Syndrome – A Complicated Relationship Donald Stone Background: Several avenues of research and clinical observation suggest that Sjogren’s syndrome (SS) is an autoimmune disease that triggers inflammatory responses. Tobacco smoking is associated with worsening of some inflammatory conditions such as rheumatoid arthritis, but with amelioration of others such as ulcerative colitis and mucosal Behçet’s disease. 32 Saudi Ophthalmology 2016: Program and Abstracts Purpose: Evaluate the association of tobacco smoking with the diagnosis and clinical features of SS in a carefully characterized cohort. Methods: Cross-sectional case-control study of patients with sicca symptoms in a multispecialty SS research clinic. Patients with SS were compared to non-SS sicca patients. Smoking prevalence was also compared to a systemic lupus erythematosus cohort and community prevalence data. Results: The current smoking rates were 2.7% for SS patients, 10.5% for non-SS sicca patients (p=0.0019), and 18% (p=1.33x10-7) and 26% (p=3.50x10-18) in a lupus and community cohort respectively. The previous smoking rates were similar for SS and non-SS patients. A comparison of subjective ocular surface complaints revealed 53.6% of those with dry eye symptoms reported ever smoking (current or past), compared to 76% of those without ocular symptoms (p=0.0453). Smoking was also associated with a lower focus score on lip minor salivary gland biopsy (OR 0.24, P=0.0017) Conclusion: SS and keratoconjunctivitis sicca are associated with a lower likelihood of current smoking. Patients with ocular symptoms were less likely to have ever smoked in the past. The mucosal irritating effects of tobacco smoking may serve as a deterrent in patients with keratoconjunctivitis sicca associated with SS; however an immunosuppressive effect of tobacco use cannot be excluded. The lower lip biopsy focus score suggests a local immunosuppressive effect of tobacco smoking. Ocular Pathogens and Antibiotic Sensitivity in Bacterial Keratitis Isolates at King Khaled Eye Specialist Hospital (2011-2014) Huda S. Al-Dhaheri Background: To investigate prevalence and in-vitro susceptibility trends of commonly isolated bacteria among patients with bacterial keratitis from 2011-2014 in a tertiary care eye hospital in Saudi Arabia. Methods: We retrospectively reviewed bacterial isolates from corneal scraping of eyes with microbial keratitis. The most common isolates and their antibiotic resistance profiles were identified; trend analysis was performed over the study period. Results: There were 3,506 bacterial isolates during the study period. Gram positive bacteria accounted for 91.4% of isolates. They mainly included Staphylococcus epidermidis 962 (27.4%), other coagulase-negative staphylococci 289 (8.2%), Staphylococcus aureus 237(6.8%), and Streptococcus pneumonia 159 (4.5%). Pseudomonas aeruginosa was the most common gram negative isolate (38.4%). All tested isolates maintained 100% sensitivity to vancomycin over the study duration. As a whole, isolates were most sensitive to moxifloxacin and ciprofloxacin with resistance of 3.7% and 3.3% respectively. Oxacillin resistance was increasingly found in Staph. aureus (14.8% in 2011 to 27.8% in 2014. P<0.05) but was without significant change in Staph. epidermidis and other coagulase-negative Staph (range 19.4-32.0%). Staph. aureus isolates demonstrated an increase in moxifloxacin resistance from 2011 - 2014, increasing from 0 to 14% (P=0.05). Using a logistic regression model, the change in resistance of bacteria to antibiotics by year was not significant (P<0.05). Conclusion: Gram positive bacteria represented the majority of bacteria isolated, with a significant prevalence of methicillin resistance in Staphylococcus species. Fluoroquinolone resistance was lower than in other regions, but may be increasing. There was no overall significant trend in antibiotics resistance, however a longer duration surveillance study is recommended. Update on The Management of Parasitic Keratitis Elmer Tu There are a variety of organisms which may be classified as parasitic keratitis making a consistent approach to their diagnosis and treatment difficult. These infections can generally be classified as direct infections of the cornea ( exogenous) or indirect spread ( endogenous). While Onchocerciasis, a parasitic infection of endogenous origin from a systemic infestation, remains the most significant infection affecting in terms of corneal blindness, Acanthamoeba and Microsporidia constitute the most significant isolated parasitic infections of the cornea. These infections are always more difficult to diagnose and treat because of their rarity which lowers clinical suspicion early in the disease course and the lack of development of effective therapies because of the small number of patients affected. Special Saudi Ophthalmology 2016: Program and Abstracts 33 laboratory and histologic tests as well as imaging are necessary in order to detect these infections and selection of anti - parasitic medications is limited and poorly supported by antimicrobial sensitivity testing. Specific management strategies will be discussed as well as unusual complications which may affect prognosis. T1B – Neuro Ophthalmology Acupuncture Treatment in Patients with Optic Neuropathy Md. Anwarul Azim Background: Glaucoma can damage the optic nerve and results in vision loss and blindness. Anyone can develop glaucoma. Although, a large amount of research is done to improve its diagnostics, prevention and treatment, it remains a major problem of modern ophthalmology. Purpose: To estimate the application of the acupuncture treatment, and modern energy-informational method bio resonance therapy (BR_) for optic neuropathy. Methods: In my clinic Doctor Azim Ltd 15 patients with optic neuropathy have been surveyed and have passed the treatment by acupuncture, needle reflexo therapy (NRT), acupressure, bio resonance therapy (BRT) by fixed frequency waves (impulses), and multi resonance therapy (MRT): induction therapy and bio resonance therapy along meridians (organs and systems) for one year supervision. Results: All patients regardless of their age noticed general somatic symptoms improvement, irritability decrease, sleep normalization, visual fatigue decrease. In all cases an increase of visual acuity from 20 up to 40 % and visual field restoration were marked. Some subjective symptoms have also disappeared or have been considerably reduced, such as: mycropsia, metamorphopsia, infringement of color perception. Conclusions: 1. Acupuncture and bio resonance therapy are highly effective non-medicamentous ways of the optic neuropathy treatment. 2. The application of the above-mentioned methods results in partial or full restoration of visual functions which is both effective and safe. 3. In carrying out acupuncture and bio resonance therapy the adverse side effects and complications have not been revealed. T1B – Retina High Mobility Group Box-1 Regulates The Expression of Matrix Metalloproteinase-9 in Diabetic Retina Mohammad Ghulam Purpose: To test the hypothesis that upregulated expression of the pro-inflammatory cytokine high-mobility group box-1 (HMGB1) in the eyes from patients with proliferative diabetic retinopathy (PDR) regulates the expression of matrix metalloproteinase-9 (MMP-9) in diabetic retina. Methods: Vitreous samples from 25 PDR and 17 non-diabetic patients, retinas from 1-month diabetic rats and normal rats intravitreally injected with HMGB1and human retinal microvascular endothelial cells (HRMEC) were studied with the use of enzyme-linked immunosorbent assay, Western blot analysis and RT-PCR. We also studied the effects of HMGB1 inhibitor glycyrrhizin and targeted deletion of the MMP-9 gene on diabetes-induced biochemical changes in the retina. An assay for in vitro cell migration was performed on human retinal microvascular endothelial cells (HRMEC). Results: Levels of HMGB1 and MMP-9 were significantly higher in the vitreous fluid from PDR patients compared with non-diabetic patients (p<0.001 for both comparisons) and these were significantly correlated (r=0.5, p=0.003). Diabetes induction and intravitreal injection of HMGB1 in normal rats induced significant upregulation of MMP-9 and downregulation of tissue inhibitor of metalloproteinase-1 (TIMP-1) mRNA levels. Constant glycyrrhizin intake from onset of diabetes attenuated diabetes-induced upregulation of MMP-9, but did not affect TIMP-1 expression in the retina. Deletion of the MMP-9 gene in mice did not inhibit diabetes-induced upregulation of HMGB1 in the retina. However, the MMP-9 inhibitor inhibited HMGB1-induced MMP-9 upregulation and migration in HRMEC. Conclusions: Our findings suggest that MMP-9 acts downstream of HMGB1 and mediates the effect of HMGB1 in diabetic retinopathy. 34 Saudi Ophthalmology 2016: Program and Abstracts Vitreous Levels of Placental Growth Factor Correlates with Activity of Proliferative Diabetic Retinopathy and Is Not Influenced by Bevacizumab Treatment Eman Al Kahtani, Elia J. Duh Purpose: Placental growth factor (PlGF) is a member of the VEGF family that plays an important role in experimental models of diabetic retinopathy and retinal neovascularization. We aimed to investigate whether vitreous levels of PlGF correlated with proliferative diabetic retinopathy (PDR) status, VEGF levels, and bevacizumab treatment. We also analysed PDR membranes to confirm the presence of the PlGF receptor, Flt1, in endothelial cells. Methods: Case-control study: Undiluted vitreous fluid samples were obtained from 28 active PDR patients without bevacizumab treatment, 21 active PDR patients with bevacizumab treatment, 18 inactive PDR patients, and 21 control patients. PlGF and VEGF levels in samples were determined by enzyme-linked immunosorbent assay. Immunohistochemistry for Flt1was performed on human PDR membranes. Results: Compared to control, vitreous PlGF levels were higher in both active PDR without bevacizumab (P< 0.0001) and with bevacizumab (P<0.0001). There was no significant difference in PlGF between active PDR patients without and with bevacizumab (P = 0.56).Compared to active PDR, PlGF levels were significantly reduced in inactive PDR (P = 0.004). PlGF levels were highly correlated with VEGF levels in active PDR. VEGFR1 was expressed in endothelial cells in human PDR membranes. Conclusion: The strong correlation of PlGF levels with PDR disease status and expression of Flt1 in human PDR membranes suggest that PlGF has a pathogenic role in diabetic retinopathy. Therapeutic targeting of PlGF with agents like aflibercept may be beneficial. Identification of Serum Molecular Signature for Proliferative Diabetic Retinopathy in Saudi Patients with Type 2 Diabetes Eman Al Kahtani, Jiang Qian Purpose: Proliferative diabetic retinopathy can eventually lead to vision loss without timely detection and treatment. We aimed to identify predictive serum biomarkers capable of detecting patients with proliferative diabetic retinopathy (PDR). Methods: A total of 40 patients with diabetes were recruited at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia and they were separated into two groups. Of these patients, 20 have extensive PDR, while other 20 have mild non-proliferative diabetic retinopathy [NPDR]. The two groups were matched with age, gender and duration of diabetes history. We examined whole genome expression of blood samples using RNA-seq. We built a model using support vector machine (SVM) approach to identify a combination of genes that can classify the two groups. Results: Differentially expressed genes were calculated from a total of 25,500 genes. Six genes (CCDC144NL, DYX1C1, KCNH3, LOC100506476, LOC285847 and ZNF80) were selected from top 26 differentially expressed genes and a biomarker was built based on the expression of the 6 genes. The mean area under ROC was 0.978 in the cross validation. The corresponding sensitivity and specificity were 91.7% and 91.5%, respectively. Conclusions: The combinatorial biomarker identified herein is a potentially useful biomarker for detecting proliferative diabetic retinopathy in patients with diabetes. T2A – Cataract Session Toric IOLs in Patients with Previous Corneal Refractive Surgery and Ectasias Enrique J. Suarez Personal experience with Toric Intraocular Lenses in 255 cases with previous Corneal Refractive Surgeries (Radial Keratotomy, LASIK) and Corneal Ectasias (Keratoconus, Pellucid Marginal Degeneration) will be presented. Saudi Ophthalmology 2016: Program and Abstracts 35 T2C – Neuro Ophthalmology Clinical Variability in Wolfram Syndrome Alberto Galvez Introduction: Wolfram syndrome is an autosomal recessive disease characterized by the presence of diabetes mellitus (DM), optic atrophy (AO), central diabetes insipidus, hearing loss and neurological disorders such as cerebellar ataxia and psychiatric manifestations. It is caused by mutations in the WFS1 gene. The aim of this study is to present a sample of 16 patients with Wolfram syndrome. Methods: We present a sample of 16 patients with Wolfram syndrome, analyzing mutations in the WFS1 gene and describing the clinical manifestations. We performed a complete neurological and ophthalmological examination of these patients, including visual perimetry, fundus and OCT (optical coherence tomography) of optic nerve, when the age of the patients allowed a proper cooperation. Results: All individuals in the sample have mutations in the WFS1 gene, communicating in this work at least 5 new mutations not described in the scientific literature. All patients have optic atrophy and ceco-central visual defects in perimetry. However, other typical clinical manifestations present in Wolfram syndrome varies greatly in its clinical expression. In this manner in this sample are presented in one hand patients with mild visual disturbances secondary to optic atrophy, without any other clinical alteration; and patients with severe optic atrophy, diabetes mellitus, diabetes insipidus, deafness and severe ataxia. Conclusions: The sample presented here shows that the spectrum of clinical expression of this syndrome is very variable, without an adequate phenotype-genotype correlation. Saudi Ophthalmological Gold Medal Lecture Gene Therapy Results from the RPE65 Phase 3 Trial for Lebers Congenital Amaurosis Phase 3 Trial of AAV2-hRPE65v2 (SPK-RPE65) to Treat RPE65 Mutation-Associated Inherited Retinal Dystrophies: Aggregate 1-Year Outcomes Stephen Russell, Jean Bennett, Katherine A. High, Daniel C. Chung, Jennifer A. Wellman, Albert M. Maguire Purpose: Multiple early-phase human trials provided preliminary evidence of safety and efficacy for adeno-associated virus-mediated human RPE65 augmentation for RPE65-mutation-associated inherited retinal dystrophies. Here we report baseline demographics, safety, and one-year aggregate outcomes of a Phase 3, open-label, randomized, controlled trial that began in November 2012 at Children’s Hospital of Philadelphia and the University of Iowa evaluating the safety and efficacy of AAV2-hRPE65v2 (SPK-RPE65) to treat RPE65-mutation-associated disease (NCT00999609). Methods: Twenty-eight eligible subjects with disease-causing biallelic RPE65 mutations were randomized 2:1 to intervention or control. Eligibility criteria included age ≥3 years-old; bilateral visual acuity worse than 20/60 and/or visual field less than 20 degrees in any meridian; evidence of sufficient viable retinal cells; ability to be evaluated on mobility testing; and willingness to provide consent or parental permission and assent, where appropriate. Subjects in the intervention group received subretinal injections of AAV2-hRPE65v2 sequentially to each eye within an 18-day window. Using a standardized subretinal delivery procedure and under general anesthesia, 1.5E11 vector genomes/ eye were delivered in a total volume of 300 µl. Standardized mobility testing under different luminance conditions was the primary efficacy endpoint. Results: All subjects completed Year 1 follow-up testing. Analyzed on a modified intent-to-treat basis, the mean bilateral mobility test scores (performance at 1 year compared with baseline) for the intervention group show a mean difference of 1.6 light levels (p < 0.004). A similar time course was found for the mean bilateral full-field light sensitivity which improved at one year by 2.10 log units (p < 0.001). Aggregate visual acuity improvement did not reach statistical significance. However, acuity improved by 3 lines in 7 of 15 intervention eyes (1st eye), 4 of 15 intervention eyes (2nd eye) and in none of the controls. Conclusions: Results of this study, the first Phase 3 gene therapy study completed for a retinal dystrophy (and for any genetic disease), provides additional evidence regarding the efficacy and safety of gene therapy intervention by surgical subretinal administration of AAV2-hRPE65v2 (SPK-RPE65) as measured by mobility testing, visual acuity and safety. 36 Saudi Ophthalmology 2016: Program and Abstracts T3B – Prevention of Blindness Validity and Usefulness of ‘RetEval’ – A Hand-held Electro-physiological Tool in Diabetic Retinopathy Screening Compared to Conventional Digital Fundus Photography Md. Anwarul Azim Purpose: To study the validity, time required to detect different stages of diabetic retinopathy in eyes by using a handheld electro-physiological tool compared to digital fundus photography. Method: Patient with diabetes attending eye screening unit of King Khaled Eye Specialist Hospital were evaluated for the presence and the grade of DR by performing electrophysiological test using RetEval’(LKC technologies Inc, USA). Each eye was also tested for digital fundus photography after pupillary dilatation using three fundus images. The time taken and feedback of screener and patient were noted. Fundus images were evaluated by retina specialist. The sensitivity and specificity of DR screening by RetEval compared to photography were calculated. Result: The prevalence of sight threatening diabetic retinopathy (STDR) and DR was 23% and 42.9%. We screened 510 eyes of 255 patients. 68 eyes of 34 patients passed the RetEval test and 442 eyes of 221 patients failed the test. Digital photography was possible in 416 eyes only. PDR was present in 35 (13.6%) of eyes. The sensitivity and specificity of RetEval test to detect PDR was 100% & 15% respectively. The sensitivity and specificity of RetEval test to detect DR was 95.5% & 25.4% respectively. The mean time for RetEval test was 5.7 ± 2.3 minutes. The median time for digital fundus photography (n = 202) was 20 minutes (25% quartile 15). In 47 (18.4%) patients who could not be assessed by digital fundus photography due to media opacities, one could undertake DR screening with RetEval. Conclusions: RetEval seems to be a good 1st level screening tool for detecting sight threatening diabetic retinopathy and DR to suggest prompt action for STDR cases and preventive measures for DR cases. Risk of Glaucoma in Obstructive Sleep Apnea Patients in King Abdulaziz University Hospital Alberto Galvez Purpose: Glaucoma is a group of disorders with characteristic optic neuropathy leading to unique visual field defects and increased cupping of the optic disc. Recently, much attention has been drawn to the possible link between Obstructive Sleep Apnea (OSA) and Primary Open Angle Glaucoma (POAG). In the present study, we aim to investigate the relationship between OSA and glaucoma. Whether OSA increases risk of developing glaucoma or has a direct causative effect is still an issue of debate among researchers. The link between the two disorders has been postulated to be due to the effect of hypoxia and impaired autoregulation of optic nerve perfusion that occurs in OSA .This study may help the researchers for better understanding the link between the two entities and guide clinicians regarding appropriate screening. According our knowledge, this is the first study to investigate the association locally. Method: Case Control study involving 40 OSA patients with Apnea Hypopnea Index ( AHI) = 5 and 30 controls with AHI < 5. Exclusion criteria: patients on steroids, those with narrow angle of anterior chamber or with other ocular diseases such as cataract, diabetic retinopathy and keratoconus. All subjects underwent a screening visit followed by a confirmatory visit if glaucoma was suspected. Informed consents were obtained from all participants and an approval was granted from the Ethical Committee at our hospital. Results: The association between OSA and glaucoma was significant, P = 0.034. Six patients from the OSA group (15.0%) were diagnosed with POAG, while no subjects from the Control group were found to have the disorder. Correlation of AHI with Intraocular pressure (IOP) is significant , r=0.2, P = 0.03. None of the presumed predictors of glaucoma (gender, age, BMI, DM, HTN, smoking, ex-smoking status and family history of glaucoma) were confounders in the relationship between OSA and POAG. Conclusion: Although we found a significant correlation between AHI and IOP and a significant relationship between OSA and POAG. Thus, we recommend that all OSA patients to be referred to Ophthalmology clinics for full glaucoma assessment. Saudi Ophthalmology 2016: Program and Abstracts 37 T3C – Optometry - Low Vision The Log MAR Visual Acuity Calculator — Making Certain Decisions for The Prescription of Magnification Alan Johnston Visual acuity is one of the most common functional attributes measured by clinicians, optometrists and vocational assessors for employment suitability. The original Snellen chart has inconsistencies in layout that were addressed by logMAR, with the introduction of precise symbol design, spacing and progression of size. Each line of symbols is 1.26 times larger than the previous, a geometric progression in size that is also 100.1, or a log 0.1 linear progression. The advantage of this format is the ability to use charts at non-standard viewing distances to measure severe visual impairment and predict the need for magnification to meet patient goals. LogMAR is particularly well suited for the prediction of near magnification to provide confident outcomes for daily tasks such as reading. The sliding scale calculator is a teaching tool that simplifies the application of logMAR principles, and includes the ETDRS letter counting score used to monitor vision status following anti-VEGF injection for neovascular AMD. The Simple Magnifier – Maximising The Interaction between Image Enlargement and Field of View Alan Johnston The ‘simple’ magnifier is usually a single lens held between the face and the page to magnify print or vocational task demand. When the magnifier is held more than its focal length away from the face, image enlargement and field of view may be less than indicated by the manufacturer but not in an intuitive way. Understanding how these functions interact enables us to prescribe magnifiers so that predicted magnification is realized with a field of view wide enough to accomplish the task. Options for specific patient demands are spectacle magnification, head borne loupes, hand-held and stand magnifiers. Smartphone and electronic magnification may be good alternatives to optical magnification, but present other demands on near spectacle prescription. The Low Vision Telescope – An Underused but Highly Effective Device for Distance and Intermediate Visual Tasks Alan Johnston Optical magnification that is independent of viewing distance requires a telescope. Galilean and Keplerian telescopes have specific but quite different properties that affect their suitability for different purposes. Binoculars and monoculars can be hand-held, but spectacle mounted types may be more suitable for sustained vocational use or where both hands are occupied on a task. In this lecture I review the concepts of image and object space, vergence amplification that limits accommodation effectiveness through a telescope, focusing options, eyepiece design and practical decisions relating to weight, field of view, binocularity and spectacle mounting for bioptic use. Practical advice for telescope trial and prescription is given. T4A – Cataract Session Assessment of Learning Curve in Phacoemulsification Surgery among Eastern Province Ophthalmology Program Residents Abdullah A. Al-Marshood Purpose: To evaluate the learning curve in phacoemulsification surgery training among program residents, and to investigate the prevalence of complications. 38 Saudi Ophthalmology 2016: Program and Abstracts Method: A questionnaire is filled by the attending surgeon after each resident’s phacoemulsification surgery. A proficiency grade is given for each step of the surgery. Total proficiency level is correlated with the resident’s experience level. All complications, if happened, are noted. Results: Under analysis Utility of Verus Ring in Performing Safe and Efficient Capsulorhexis with Corneal Scarring Enrique J. Suarez Purpose: The Verus ring is a silicone ring-shaped intraocular device that can be injected onto the anterior lens capsule that can assist with sizing and centration of the capsulorhexis. Capsulorhexis during cataract surgery in patients with corneal scars can be challenging. In this study we determine the safety and efficacy of the Verus ring during anterior capsulorhexis. Methods. Eyes with mild to moderate corneal scars undergoing cataract surgery (n=12) were subjected to implantation of the Verus ring during capsulorhexis by a single surgeon. Outcome measures included complications during the capsulorhexis procedure and time taken to complete the capsulorhexis and surgeon feedback. Historical and surgeon controls (n=12) for capsulorhexis in patients with clear cornea were used as a comparative group. Results: There were no complications related to the insertion and removal of the device. Anterior capsular extensions were not observed in any of the cases with corneal scarring. The capsulorhexis was well centered in all the eyes. The average time for capsulorhexis using the Verus ring was 25.59 seconds. Average historical and surgeon control time to perform capsulorhexis was 28.21 seconds. This difference was 2.62 stats. Surgeon feedback indicated that the insertion of the device did not require steep learning curve other than careful following the instructions as noted in the instruction video and was of the opinion that it greatly enhanced safety and efficiency during the capsulorhexis process. Conclusion: The Verus ring appears to be a useful device in performing safe and efficient capsulorhexis in patients with corneal scars undergoing cataract surgery. Comparison between Digital and Manual Marking for Toric Intraocular Lenses Hany A. Helaly Setting: Faculty of Medicine, Alexandria University, Egypt Purpose: To compare the clinical outcome of digital and manual marking for toric IOL alignment. Methods: This is a prospective clinical study that included 60 eyes of 60 patients undergoing cataract surgery with coexisting corneal astigmatism more than 1 diopter (D). The eyes were randomly assigned to either digital image guidance using VERION digital marker (Alcon Laboratories, Ft. Worth, USA) or manual slitlamp-assisted preoperative marking using pendulum-attached marker. Tecnis toric IOL (Abbott Medical Optics, Inc, Santa Ana, California, USA) was implanted in all cases. Results: The mean postoperative UCDVA for the digital marking group was 0.12 + 0.12 logMAR, and for the manual marking group was 0.18 + 0.14 logMAR (p = 0.104). The mean deviation from targeted induced astigmatism (TIA) for the first group was 0.10 + 0.08 D and for the second group was 0.20 + 0.14 D (p = 0.001). The mean postoperative toric IOL misalignment measured by the slitlamp was 2.4 + 1.96 degrees for the first group and was 4.33 + 2.72 degrees for the second group (p = 0.003). Conclusion: Accurate alignment of the toric IOL is important to achieve the desired astigmatism correction. VERION system has the advantage of preoperative planning and intraoperative digital guidance of the toric IOL alignment. The use of VERION system resulted in less postoperative deviation from TIA and showed less postoperative toric IOL misalignment than using manual marking technique. Saudi Ophthalmology 2016: Program and Abstracts 39 Wednesday, March 9 W1A – Cornea Session The Challenge of Herpetic Viral Keratitis Elmer Tu The Herpes family of viruses which may affect the cornea and anterior segment include Herpes simplex (HSV), Herpes zoster (HZV), Epstein Barr (EBV) and cytomegalovirus (CMV). Herpes simplex virus is the most common cause of visual loss in developed countries and has one of the highest prevalences of any infectious disease around the world with nearly 100% of those aged 70 or over having evidence of HSV infection. Primary infection may manifest as a blepharoconjunctivitis, epithelial keratitis, stromal keratitis, endotheliitis, trabeculitis, or anterior uveitis and glaucoma. Landmark studies including the HEDS have given guidelines for management of these viral infections, but cure is elusive. Vaccinations for HZV promises to change the paradigm of HZO management, but in ways that are not clearly understood. CMV is an emerging cause of corneal failure and glaucoma that is poorly recognized early in the process. Treatment options will be discussed for Herpes virus infections of the anterior segment. Clinical Results of a Foldable Artificial Cornea: Personal Experience Jose M. Vargas Purpose: To evaluate the safety and effectiveness of a foldable artificial cornea for the treatment of cornea blindness. Methods: 19 Patients with corneal blindness due to failed grafts, burns, scars, dystrophies and Keratoconus had the Keraklear artificial cornea implanted into a corneal pocket using a femtosecond laser. Results: 100% of these patients had improvement in vision. There were no cases of endophthalmitis , retroprosthetic membrane or glaucoma. There was one case of infection and one case of corneal melt. Follow up was from 38 to 50 months. Conclusion: These results of the Keraklear artificial cornea show that this device can improve vision in cornea blind patients and may be used as an alternative to PKP as a primary procedure. The Unique Role of Confocal Microscopy in the Diagnosis of Corneal Disease Elmer Tu In recent years, an unprecedented expansion in our capabilities in imaging the anterior segment of the eye has occurred. These technologies include anterior segment Optical Coherence Tomography (OCT), Scheimpflug imaging, Ultrasound Biomicroscopy, and Confocal Microscopy. All of these technologies have their strengths as well as considerable overlap in their ability to provide accurate depth, corneal curvature and anterior segment anatomy detail. The exception is confocal microscopy which provides cellular detail in an en face image which allows correlation with traditional histology but in vivo, but only images the cornea well. The best known use for confocal microscopy is in the diagnosis of atypical forms of infectious keratitis where organisms are large and the cornea is only mildly suppurative as to allow contrast from surrounding structures. It has shown great utility in the diagnosis and management of fungal and acanthamoeba keratitis. As the technology becomes more commonly available, other indications including diagnosis of epithelial disorders, corneal innervation abnormalities, corneal dystrophies as well as endothelial disorders such as epithelial downgrowth, iridocorneal endothelial syndrome and Fuchs dystrophy are becoming better known. 40 Saudi Ophthalmology 2016: Program and Abstracts Corneal Myxoma: Presentation and Management - Case Series Bader S. Al-Qahtani Purpose: To describe presentation and outcome of management of eyes with corneal myxoma. Methods: This was a retrospective review of cases presented with corneal myxoma at cornea unit of King Khaled Eye Specialist Hospital between January 2001 and October 2014. The demographic, clinical evaluation, mode of treatment and final outcomes in relation to visual acuity, corneal clarity and duration of follow up were evaluated. Results: We had ten eyes of ten patients with clinical diagnosis of corneal myxoma that was confirmed subsequently by histopathology. The preoperative vision was 20/20 to 20/40 in three eyes. Two patients had family history of anterior segment dysgenesis. Four had defective vision and one had discoloration of affected eye. Eight eyes were treated by penetrating keratoplasty and one had keratectomy. Lesion was white opaque in seven eyes, one was dome shaped and two had hydrops. The median size of lesion was 46mm2. Four eyes had stable graft. One had phthisis, two had peters anomaly and one had graft rejection. Vision was 20/20 to 20/60 in four eyes, <20/60 to 20/200 in one eye and <20/200 to 20/400 in two eyes. Conclusion: Corneal myxoma a rare anomaly could be managed with penetrating keratoplasty and restoration of vision was possible in 80% of eyes. Safety of Long-term Treatment with Topical Tacrolimus 0.01% Eye Drops Samir S. Shoughy Purpose: To evaluate the safety and efficacy of long-term term use of topical tacrolimus 0.01% eye drops in patients with vernal keratoconjunctivitis (VKC). Methods: We included a total of 26 consecutive patients with VKC resistant to conventional therapy. Signs and symptoms were recorded before and after therapy. Ocular and systemic side effects were monitored. Results: There were 22 male and 4 female patients with a mean age o 16 years. The follow up period ranged from 6 to 29 months. There were statistically significant improvement of all signs and symptoms. None of the patients developed elevation of intraocular pressure, cataract, infectious keratitis or systemic side effects. Conclusion: Topical tacrolimus 0.01% is safe and effective for long-term treatment in patients with VKC. The Diagnosis and Management of Ocular Surface Tumors Elmer Tu Although most ocular surface tumors are either benign or slow growing, conjunctival malignancies are one of the few disorders of the anterior segment which can result in significant morbidity and mortality. Diagnosis, management and prognosis are highly dependent on the underlying origin of the tumor. Those of squamous origin tend to be slow growing, slow to invade and locally recurrent while those of pigment epithelial origin have a risk of malignant transformation, local invasion and distant metastases which may result in death several years later. Differentiating melanocytic tumors as benign or malignant by clinical appearance can be unreliable with pathologic examination required regardless of underlying race or ethnicity in at risk lesions. Lymphoid tumors and inflammatory lesions are often difficult to discern and may also have systemic implications, although many remain restricted to the eye. Treatment of lymphocytic tumors is rarely local excision alone and may require local irradiation for control with all of its attendant side effects. Melanocytic lesions require excisional biopsy with wide margins and adjunctive cryotherapy to reduce risk of recurrence and distal spread. Chemotherapeutic regimens for melanocytic lesions is controversial with mitomycin C as the most common agent. The options and management of squamous lesions offer the most options with the introduction of a number of topical chemotherapeutic drugs including mitmoycin C, but also 5fluorouracil and interferon alpha 2b which result in successful management in greater than 80% of cases. Excisional biopsy remains a proven option, but incisional biopsy, imaging, impression cytology and other modalities have been employed as alternative prior to institution of chemotherapy malignancies of squamous origin. Saudi Ophthalmology 2016: Program and Abstracts 41 W1C – Optometry – The Role of Optometrists in The Delivery of Eye Health Care The Need for Eye Care Michael Kalloniatis The aim of this lecture is to provide an overview of the likely areas of need relating to vision impairment and blindness that Saudi Arabia may face. Using available statistics relating to economic development and causes of vision loss throughout the world, comparisons will be made with other countries to identify similarities and differences in major causes of vision loss in Saudi Arabia. Models Integrating Optometrists in Eye Health Delivery Michael Kalloniatis The aim of this lecture is to identify possible models of vision care that may assist in dealing with current and future needs. After reviewing ophthalmic manpower (ophthalmologist and optometrist numbers), the scope of practice of optometry will be discussed and how various models have been used integrating ophthalmologists, optometrists, nurses and other personnel in ophthalmic health care delivery. Models in the UK and Australia where optometrists have been integrated in ophthalmic patient pathways will identify possible ways to integrate optometry into health care delivery. Evidence-based Approach to Improving Optometrist Contribution to Eye Health Care Importance of Education Michael Kalloniatis The aim of this lecture is to outline research showing the importance of education to improve the optometric contribution to health care delivery. Studies from the UK showing increased education leads to better referrals by optometrists will be followed by research from our Centre highlighting some clinical skills areas requiring attention and how further education leads to better outcomes. The studies will include a review of the efficacy of optometrists in diagnosis and follow up of patients with glaucoma. The importance of improved optometric education correlated with improved management will be highlighted. The Future of Eye Health Care Michael Kalloniatis The aim of this lecture is to identify areas where optometry can contribute to health care delivery. These include participation in epidemiological research; population awareness; service delivery; planning intervention and evaluating outcomes and planning optometric education programs and evaluating competencies. W2A – Retina Automated Detection of Diabetic Retinopathy and the Need for Telescreening Stephen Russell Purpose: The population of patients at risk for Diabetic Retinopathy (DR) is increasing due to: 1) increasing preva- 42 Saudi Ophthalmology 2016: Program and Abstracts lence of diabetes mellitus in the population, 2) aging demographics, and 3) less active lifestyles. To combat this “perfect storm” we compared the sensitivity and specificity of the IDx-DR photographic device to clinical examination by ophthalmologists to identify Diabetic Eye Disease (DED). Methods: Five hundred-twenty eight patients were recruited at seven sites that included general ophthalmology or retinal specialty practices. Criteria for inclusion was diagnosis of diabetes; age ≥18 years; no history of other ocular diseases affecting the retina or optic nerve. Ophthalmologists performed a dilated fundus examination including stereoscopic biomicroscopy. Two, 45°, color photographs of each eye were taken with a Topcon NW 200 nonmydriatic camera. Images were processed by the IDx-DR v1.0 algorithm and graded at a central reading center by readers masked to results of the clinical examination and the device. DED was defined as more than mild nonproliferative diabetic retinopathy as detected by the Reading Center (>= ETDRS level 35) or macular edema within one disc diameter from the fovea as detected by either the Reading Center or the ophthalmologist. Patients were classified based on the worst gradings of the 2 eyes. Results: Prevalence of DED was 38.1% (201/528). Sensitivity was 86.1% (173/201) for the device compared to 53.7% (108/201) for clinical examination; the difference was 32.3% (95% CI: 25.1% to 38.2%). Specificity was 68.5% (224/ 327) for the device compared to 99.1% (324/327) for clinical examination; the difference was -30.6% (95% CI: -35.8% to -25.7%). When DED was restricted to potentially treatable disease (severe nonproliferative or proliferative retinopathy or macular edema), sensitivity was 96.8% (61/63) and compared to 95.2% (60/63) for clinical examination; the difference was 1.6% (95% CI: -4.7% to 8.8%). Differences were similar for different racial and ethnic groups. Conclusions: The IDx-DR automated screening detected a higher proportion of people with Diabetic Eye Disease than clinical examination. For treatable disease, automated screening was comparable to clinical examination. Lowcost application of automated detection of DED (using IDx-DR) would avoid the adverse burden on eye care practitioners of screening increasing numbers of “at risk” patients with diabetes. Congenital Stationary Night Blindness with Defective Signal Transmission at the Level of the Bipolar Cells Patrick Schatz Purpose: To describe a family with complete stationary night blindness (CSNB). Method: Clinical examination including Magnetic Resonance Tomography (MRI) of the brain, optical coherence tomography and electrophysiological examination. Results: Two siblings with CSNB presented with nystagmus, high myopia, hypoplastic discs and negative electroretinogram with no measurable rod response. MRI was done in both to rule out midline abnormalities in the central nervous system. Retinal structure was analyzed qualitatively with spectral domain optical coherence tomography, showing normal retinal structure and layers. There was no significant change in the electroretinogram after prolonged 2 hour dark adaptation compared to standard 30 minute dark adaptation. Conclusion: These clinical findings are compatible with complete CSNB. The lack of improvement of rod responses after prolonged dark adaptation is in keeping with a postreceptoral transmission dysfunction in the bipolar cells in this form of CSNB. This is discussed in relation to findings in other types of CSNB. Methods and Surgical Technique for Gene and Cell-Based Retinal Therapies Stephen Russell Gene therapy is a new and potentially revolutionary treatment for inherited and non-inherited ocular diseases. General concepts of gene replacement and several currently active trials will be discussed including the pivotal FDA Phase III RPE65 study. Trials involving extension of gene therapy to non-inherited diseases such as age-related macular degeneration will be presented. Coats’-like Retinopathy in Joubert Syndrome Salwa K. Al-Shibani An 11-year-old girl with Joubert syndrome (JS) was evaluated because of a dim red reflex in her left eye. Fundus Saudi Ophthalmology 2016: Program and Abstracts 43 examination revealed features of Coats’-like pigmentary retinopathy bilaterally, a phenomenon not previously reported in JS. The exudative retinopathy was controlled after multiple sessions of indirect laser photocoagulation and cryotherapy with a good visual outcome. Coats’-like exudative retinopathy may occur in JS and other ciliopathies. Permanent visual loss may occur if the process is left untreated, so early diagnosis and treatment are vital to achieve a good final visual outcome. W3A – Refractive Surgery Session Outcome of Intrastromal Corneal Ring (INTACS SK) using Femtosecond Laser in Keratoconus Patients (KKESH Experience) Awad A. Al-Qarni Purpose: To evaluate the safety and efficacy of appropriate thicknesses of Intacs SK in all stages of KC and in form frusta keratoconus using femtosecond assisted laser technology, to assess the outcome, complications, rate of removal of Intacs SK segments , and the need for secondary surgeries after Intacs SK . Methods: In this retrospective, all keratoconus patients file (diagnosis based on clinical and topographic data ) who underwent INTACS -SK between January 2008 to July 2013 in King Khaled Eye Specialist Hospital were reviewed. The Amsler-Krumeich keratoconus classification used to categorize keratoconus patients . Data collection sheet for preoperative and postoperative examinations include: slit lamp evaluation, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, spherical equivalent, cylinder power, pachymetry, keratometry data, intraoperative and post operative complications, the rate of removal of INTACS-SK, and the need for secondary cross linking or keratoplasty. Results: One hundred and thirteen eyes ( of 83 patients) were identified. There were 58 [69.88%] males and 25 [30.12 %] females with mean age of 28.3 ± 6.3 years. At 6 months post operative , the median UCVA change from 20/200 (CF, 20/40) to 20/50 (CF, 20/25) . There was statistically significant decrease in both the spherical equivalent (- 5.73 ± 3.07 D to - 3.68 ± 2.59 D (P < 0.0001)) and the manifest sphere ( - 3.84 ± 3.17 D to - 2.88 ± 2.84 D (P < 0.0001)). At 2 years post operative , the median UCVA changed from 20/200 (CF, 20/40) to 20/50 (CF, 20/25) . The difference in the spherical equivalent continue to be significant (from - 5.05 ± 2.5 D to - 2.86 ± 2.14 D (P < 0.0001)). The UCVA improved more than one line in 90 eyes ( 87.3%) in 6 months , and 77 eyes (92.8%) in 2 years . While the BCVA improved in 39 eyes ( 37.9 %) in 6 months , and 27 eyes (32.5%) in 2 years. Intraoperative complication as incomplete tunnel seen in 5 eyes (4.42%), migration (2.7%). Post operative complication: dissatisfaction (12.4%), clinically significant glare (3.5%), excursion (1.8%), infection (1.8%), neovascularization (1.8%), epithelial ingrowth (0.9%). Removal of the ring done in 14 eyes (12.4 %) . Keratoplasty done in 7 eyes (6.2 %) as secondary procedure . Cross linking done for documented progression in 11 eyes (9.7%) . Conclusions: Our study demonstrated that Intacs SK is a safe and efficacious option for the treatment of patients with keratoconus who are contact lens intolerant. The improved functional vision associated with this treatment modality can defer or potentially eliminate the need for corneal transplantation. Complication of Intacs SK are uncommon and treatable. In patients whose visual outcomes is unsatisfactory due to disease progression, the segments can be removed easily and safely then corneal transplantation performed. Correlation between Practice Location as a Surrogate for UV Exposure and Practice Patterns to Prevent Corneal Haze after Photorefractive Keratectomy (PRK) Eman Al-Sharif Purpose: PRK is a refractive surgery that reshapes the corneal surface by excimer laser photoablation to correct refractive errors. One of the most important postoperative complications is corneal haze. The effect of increased UV light exposure on aggravating post-PRK corneal haze had been reported in the literature; however, information is lacking regarding the effect of ambient UV exposure on physician practice patterns. This study aims to evaluate the effect of ophthalmologists’ practice location on their employed practice patterns to prevent post-PRK corneal haze. Methods: This is a cross-sectional observational study conducted through an online survey sent to Ophthalmologists 44 Saudi Ophthalmology 2016: Program and Abstracts performing PRK in different countries. The survey recorded the primary city of practice from which the two independent variables, latitude and average annual sunshine days, were determined. It also measured the frequency of use of common postoperative preventive interventions (dependent variables) which are: intraoperative Mitomycin-C, oral vitamin C, sunglasses, topical corticosteroids, topical cyclosporine, topical tetracyclines and amniotic membrane graft. SPSS (22.0) was used for data analysis and level of significance was 0.05. Results: Fifty-one ophthalmologists completed the survey. Practice locations’ mean latitude was 37oN whereas the average sunshine days annually accounted for 60 % of year days. There was no significant relation between latitude/ average annual sunshine days and usual post-PRK prophylactic treatments (P>0.05). The commonest protective treatments were sunglasses (78%), prolonged topical corticosteroids (57%), Mitomycin-C (39%) and oral vitamin C (37%). Conclusion: We found no significant difference in ophthalmologists’ practice patterns to prevent post-PRK corneal haze in relation to practice location latitude and average sunshine days. Moreover, the results demonstrated that the most widely used postoperative preventive measures are sunglasses, Mitomycin-C, topical corticosteroids, and oral Vitamin C. 1-year Follow Up of Implantable Collamer Lens (ICL) Anismetropic Amblyopia of children Amr S. Radwan Purpose: To evaluate the safety and efficacy during 1-year follow-up of implantable collamer lens (ICL) to correct high anisometropia in amblyopic children who were non-compliant with spectacles or contact lenses. Methods: Retrospective study of 12 eyes of 12 children with high anisometropia who underwent ICL implantation (phakic posterior chamber IOL). Patient age at the time of implantation ranged from 2 to 10 years. Mean preoperative spherical equivalent refraction was -10 diopters (D). Mean logMAR uncorrected visual acuity (UCVA)was .03 and corrected distance visual acuity (CDVA) was .3.occlusion therapy was done after surgery in all cases. Results:UCVA and CDVA improved in all children. At 12 months, logMAR UCVA and CDVA were .5 and 0.7 respectively (P=.01). Improvement of more than three logMAR lines of CDVA was achieved in all children. No loss of CDVA was detected in any patient. Conclusions: ICL is a safe and effective treatment option for childhood anisometropic amblyopia. W3B – Pediatric Ophthalmology New Technique for Squint Surgery Said A. Jamaleddin Objective: To explain a new surgical technique in squint surgery and to discuss and compare with old conventional ones. Background: There is a taboo in all kinds of medicine which we did not discuss. A taboo such as conventional squint surgery and motility of the eye which we are following many years. In my study I do only myectomy/myectomy without any suture with very good results. We know that ocular muscle is controlled by brainstem. The classical surgical squint techniques mostly depend on changing the mechanical action of the muscle. By resections or recessions and thoserules explain the movement of the eye. I think there may be ocular muscles itself has control center like the heart muscle or there have been some neurogenic control (supranuclear) of ocular muscles. We don’t have any idea about these. Or there may be another rule which need to discuss more. Material and methods: I have operated about 69 primary squint patients (XT-ET and some secondary cases -reoperated). And the observations of their results after using this new technique for one year , two years and three years . Results: We found that when we do a myectomy especially to the medial rectus or lateral rectus .and leaves it as it is. There is no need to reinsert the muscle because the muscle will adjust and reinsert by itself as the eye motility require. Conclusion: This new technique is a new revolution in our ophthalmic field because it is simple, easier to do, require less time, no need of suturing, under local anesthesia no side-effects with more efficient results. And the cosmetic improvement is round 85-95 %. And the binocular vision is improved in young children about 45%. Saudi Ophthalmology 2016: Program and Abstracts 45 The Profile of Pediatric Ophthalmic Emergency Cases Presented to King Abdulaziz University Hospital’s Emergency Department in Riyadh, Saudi Arabia: A Six-month Retrospective Study Abdulrahman A. Al-Jasser Purpose: To determine the profile of pediatric ophthalmic emergency cases, the pattern of their complaints and the percentage of true emergencies among them. Taking into account the limited information available regarding the epidemiology of pediatric ophthalmic emergency cases worldwide and especially in our country. Methods: A cross-sectional study was carried out using the ophthalmic emergency registry book at King Abdulaziz University Hospital (KAUH). All pediatric cases (<13 years) presented from November 2014 to April 2015 were included. Some patients were seen and given follow-up appointments in the emergency department (E/D); their later visit was excluded as it is usually for assuring that the treatment course was followed. Results: Within the defined period, 1716 subjects presented to (E/D) primarily categorized as pediatric cases. Subjects were in the mean (SD) age of 67.6 months (43.5), out of whom, 956(55.7%) were males. Saudi citizens constituted the majority of cases 1529 (89.1%). After detailed examination, the two major diagnoses were: Corneal Epithelial Defect (CED) 481(28%) and viral conjunctivitis 288(16.8%). In terms of management, only 36 cases (2.1%) were admitted to the inpatient ward. The preliminary categorization of cases demonstrated that 1435(83.6%) were estimated as emergency cases, while the final confirmed diagnoses proved that 1345(78.4%) were actual emergency cases while 67(3.9%) were normal, and 304(17.7%) were non-emergency cases Conclusion: Our principal recommendation targets policy makers to recognize the patterns of ocular injuries in order to construct and adequately dispense resources in an efficient way and to encourage them to enforce safety measures. Moreover, raising the public awareness on first-aid practices is crucial since the most common cause of ophthalmic ER visits is CED, which is mainly caused by trauma. W3C – Retina The Lost Art of Retinal Drawing Stephen Russell Purpose: To demonstrate the relationship, variation, beauty and artistic progression of retinal drawings over a three decade span. Methods: Based upon a collection of over 12,000 retinal drawings performed by residents, retina fellows and faculty from 1958 to 1990, a variety and progression of artistic styles were observed. Images were qualitatively analyzed for style, drawing techniques and common stylistic features. Results: Over multi-year intervals, retinal drawings demonstrated some core commonalities of style, although individual artists showed numerous differences in individual interpretation and feature representation. The style of retinal drawings demonstrated a progression from realistic (1950’s and 60’s) to iconic (1970’s) to caricature/simplistic (1980’s) Conclusions: Despite great differences in the representation of individual fundus features, contemporaneous clusters of faculty and trainees share recognizable artistic styles. Retinal drawings that differ from their period style often demonstrate unique representations of fundus structures that remain rapidly comprehensible and esthetically pleasing. Similarities of representation suggest that the influence of contemporaneous colleagues likely explains the harmonization of style over time. Precision in Vitreoretinal Surgery: Manual versus Assisted Instrument Positioning Marco Mura Purpose: Vitreoretinal (VR) surgery requires a high level of surgical skill. High-precision robot assistance can improve a surgeon’s skills. E.g., higher precision improves the reproducibility of existing procedures and the development of new, high-precision procedures that cannot be performed manually. The PRECEYES Surgical System was 46 Saudi Ophthalmology 2016: Program and Abstracts developed to assist in VR surgery. The surgeon uses a motion controller to manipulate an instrument manipulator, which controls the instrument. The purpose of this study is to evaluate positional precision and steadiness of a surgeon, comparing manual and assisted instrument positioning inside the eye. Setting: Tests were performed by a surgeon in an eye simulator at the Medical Robotic Technologies lab of PRECEYES, Eindhoven, the Netherlands. Methods: To measure positional precision and steadiness, a tracing test was developed. A test model was created, resembling the VR environment. The model consisted of a hollow styrofoam bottom half which is lined inside with millimeter (mm) paper. The top half, composed of transparent plastic resembling an artificial sclera was placed above. A trocar was present through which an instrument can be inserted into the model. With the tip of the instrument a square of 4 by 4 mm was traced on the mm paper, in the region corresponding to the macula. The test person was asked to freeze the instrument for 3 seconds at the corners of the square. Image analysis was used to calculate i) the deviation between the tip of the instrument and the line that was traced and ii) the deviation between the tip of the instrument and the corners of the square during the freezing step. These deviations provide measures for positional precision and steadiness, respectively. Each test was repeated 3 times in manual and robotic mode. Results: Manual use of the instrument resulted in an average positional deviation between the tip of the instrument and the line of 80.8 _m ± 50.6 _m. The average deviation between the position of the tip and the position of the corner was 125.7 _m ± 62.9 _m. It took 62.8 ± 7.7 seconds to complete these manual experiments. Robot-assisted use resulted in an average positional deviation between the tip of the instrument and the line of 49.6 ± 28.5 _m. The average deviation between the position of the tip and the position of the corner was 55.9 _m ± 23.5 _m. It took 95.6 ± 9.4 seconds to complete these assisted experiments. Furthermore, literature shows that manual positioning precision of a good surgeon is in the order of 125 _m. Off-line experiments with the stand-alone robotic assistant have demonstrated its intrinsic precision to be below 10 _m. Its steadiness can only be compromised by movement of the eye model, as it freezes at its exact position. Conclusion: The results indicate that positional precision and steadiness in the X-Y plane, using a simulated surgical environment to be twice as high with assisted surgery as compared to manual surgery. This relative improvement is significant, whilst the difference in procedural time is relatively small. However, the absolute values of the results have to be interpreted carefully. Comparing the values from literature and off-line experiments with the measurement results demonstrates that these values are highly dependent on the imaging modality used, in this case a Zeiss OPMI stereoscopic microscope, and the interpretation of the surgeon analyzing the images in real-time and correcting the instrument positioning accordingly. Furthermore, the evaluation method will influence the results. E.g., the steadiness of the robotic system, measured whilst freezing the instrument position at the corner of the grid, was measured ± 23.5 _m. This deviation is introduced by the evaluation method and/or movement of the eye model, as the robot freezes the exact position. Summarizing, it can be concluded that assisted surgery allows for significant improvement of both positional precision and steadiness, which will benefit reproducibility of existing treatments as well as enable the development of high-precision procedures. To obtain absolute values, further experiments are required. Predicting Factors for Visual Acuity Outcomes following Surgery for Epiretinal Membranes Ali Al-Halafi Purpose: To evaluate the predicting factors for good VA after PPV for ERM. Methods: The medical records of 29 eyes seen in the Retina Clinic and diagnosed to have ERM were reviewed. Investigating potential predicting factors for achieving good vision included a mean change in best-corrected visual acuity (BCVA) before and after PPV, mean change in CMT before and after PPV, age, sex and duration of the disease. Results: In the current study, 29 eyes (19 (65.5% OD and 10 (34.5% OS) of 29 patients were recruited. The mean (SD) age of our sample was 60.8 (10.6), range [33-78]. Comparing the mean (SD) LogMAR of preoperative and the last follow-up values, the detected difference was found to be statistically significant (0.5 (0.3), [95% CI: 0.394 - 0.608]; p<0.0001). The mean (SD) OCT decreased postoperatively to 352 (128), then to 313 (101.5) in the last follow-up visit assessment, where such decrease from preoperative to the last follow-up assessment was statistically significant (139.2 (92.5), [95% CI: 103.311 - 175.046]; p<0.0001). Investigating potential predicting factors for achieving vision = 20/60, patients who entered the cohort in a relatively higher age and with a better initial visual acuity were found to be more likely to achieve better postoperative vision (p= 0.016 and 0.004 for age and visual acuity respectively). Conclusion: This study shows improvement in VA after PPV and ERM removal. Patients with better initial VA achieve higher levels of visual outcome. Postoperative improvement in vision is slow. OCT appearance cannot predict visual outcome. Saudi Ophthalmology 2016: Program and Abstracts 47 A New Complication of Cataract Surgery: Hemorrhagic Occlusive Retinal Vasculitis Stephen Russell Purpose: To review cases that represents phenotypic extremes of postoperative hemorrhagic occlusive retinal vasculitis (HORV) due to intracameral injection of vancomycin. Methods: Two cases of HORV were evaluated. Clinical evaluations included comprehensive ocular examination, testing and investigation for endogenous uveitis or non-HORV cause. Results: Case 1: A 65-year-old woman developed progressive visual loss over a 3 week period following uncomplicated cataract surgery with intracameral injection of 1 mg of vancomycin. Initially the patient was minimally symptomatic. Observed over the course of several weeks were transitory afferent pupillary defect and reductions in visual acuity, visual field, retinal hemorrhage and edema. She returned to 20/20 with minimal structural and visual sequella. Case 2: A 75-year-old male developed delayed onset, bilateral, severe sequential bilateral panuveitis and hemorrhagic occlusive vasculitis within 10 days of otherwise uncomplicated bilateral cataract surgeries with injections of 1 mg of intracameral vancomycin. Over the ensuing weeks he developed bilateral neovascular glaucoma requiring bilateral seton implants for IOP control. Conclusions: Presentation of postoperative hemorrhagic occlusive retinal vasculitis may range in severity and may require a high degree of suspicion for correct diagnosis. It is unclear whether current methods for detection (and treatment if necessary) of HORV is sufficient to assess its incidence. Role of Intravitreal Bevacizumab as Adjunctive Therapy in Retinopathy of Prematurity Khalid Al-Husseiny Purpose: To determine the effect of adding intravitreal bevacizumab to conventional laser photocoagulation in stage 3 retinopathy of prematurity (ROP). Methods: A prospective, controlled, interventional fellow eye study in patients with bilateral stage 3 ROP necessitating bilateral laser photocagulation of non-perfused retina. Patients received diode laser photocoagulation in one eye group (A) (LP group), and the same treatment in the fellow eye with the addition of an intravitreal injection of bevacizumab at the end of the procedure group (B) (LP/IVB group). The primary outcome measures were resolution of neovascularization and occurrence of retinal detachment, and secondary outcome measures were speed of resolution of plus disease, and the intensity of the cicatricial response. Results: Fifteen patients met the study criteria. Seven patients had zone I disease, and 8 patients had posterior zone II disease. All eyes (100%) in the LP/IVB group had complete resolution of neovascularization without occurrence of retinal detachment. Out of the 15 eyes in the LP group, 12 eyes (80%) had complete resolution of neovascularization, while 3 eyes (20%) had persistent neovascularization, which was successfully treated with intravitreal bevacizumab and supplemental laser photocoagulation. In the latter 3 eyes, there was an exaggerated cicatricial response compared to the fellow eye. None of the eyes in the LP group developed retinal detachment. The time from primary intervention to resolution of plus disease ranged from 2-5 days in the (A) LP/IVB group, and 7-10 days in the ( B ) LP group. Conclusion: The addition of intravitreal bevacizumab (IVB) to conventional laser photocogulation in stage 3 ROP (zones I and II) resulted in faster resolution of plus disease, more complete resolution of neovascularization, and less need for secondary intervention, without exaggeration of the cicatricial response. When IVB was added to supplemental laser treatment, the cicatricial response was more intense than cases where IVB was added to the primary laser treatment, but without the occurrence of retinal detachment. Thus IVB may be useful as an adjunct to primary laser treatment. The late addition of IVB to supplemental laser treatment requires further study. Controversies in Management of Dislocated IOLs Stephen Russell Controversies in Ophthalmology: Is it better to remove, re-position or replace this dislocated intraocular lens? Through a selection of cases, diagnostic and therapeutic challenges in managing dislocated intraocular lenses (IOLs) will be demonstrated. Optional anterior segment approaches and posterior segment choices will be reviewed. Rela48 Saudi Ophthalmology 2016: Program and Abstracts tive advantages and disadvantages of each approach will be presented. Engagement of IOA members will be encouraged through open discussion of these complex cases. W4C – Retina Positional and Other Dynamic Changes on Optical Coherence Tomography Stephen Russell Optical coherence tomographic images has proven to be a useful, and in some cases essential, imaging technique for the diagnosis and management of retinal diseases. As with all newly introduced imaging methods, OCT has progressed from a modality of observation and discovery to numerical and quantitative analysis for specific applications. Utilizing custom segmentation and image analysis of spectral domain OCT data, we will demonstrate dynamic physiologic responses within the posterior pole. Examples will include the active thickening of the choroicapillaris when changing position from sitting to lying down compared to the static thickening of the choriocapillaris found for intermediate age-related macular degeneration (AMD). Additionally, the day-to-night thickness changes of the photoreceptor outer segment length will be illustrated in normal turnover and those affected by Best disease. Use of New Intraocular Spectral Domain Optical Coherence Tomography in Vitreoretinal Surgery Marco Mura Purpose: To describe the use of a novel intraocular side-scanning probe enabling the acquisition of Spectral Domain Optical Coherence Tomography (SD-OCT) images during surgery in a series of patients with complex forms of retinal detachment. Methods: A 23 gauge, side-scanning SD-OCT probe (C7 System; LightLab Imaging, Inc/St Jude Medical, St. Paul, MN, USA) in a 20 gauge catheter was used to acquire the intra-operative Optical Coherence Tomography (OCT) images in 7 patients with vitreoretinal diseases. 25 Gauge pars plana vitrectomy (PPV) was performed in every patient in a standard fashion. After enlarging the temporal sclerotomy to a 20 gauge port, all the patients were scanned with intraocular side scanning SD- OCT, during different steps of the surgery based on surgeon needs. Scans were recorded real time and directly evaluated on a screen during surgery. OCT scans were judged beneficial when they would recognize structures otherwise not seen on biomicroscopy. Results: The intraocular SD-OCT has been helpful in acquiring extra information during vitreo retinal surgery such as the detection of the presence of otherwise invisible membranes (epiretinal membrane, subretinal membrane), the location of small tears, the identification of the retinal plane under suboptimal conditions for visualization . Conclusion: The use of an intraocular SD-OCT, can expand upon visual cues during surgery, helping in the decisionmaking process and allowing additional deliberate surgical maneuvers aimed at improving surgical outcomes. Correlation between Microperimetry and Optical Cohernce Tomography in Macular Edema Secondary to Acute Retinal Vein Occlusuon Before and After Bevacizumab Injection Turki A. Dakhil Purpose: To evaluate the relationship between retinal thickness measured with optical coherence tomography (OCT) and retinal sensitivity measured with the (MP-1) in eyes with macular edema secondary to acute retinal vein occlusion before and after intravitreal Bevacizumab injection. Methods: In this prospective study, 63 eyes were evaluated. Baseline optical coherence tomography and microperimetry were taken at presentation. 43 eyes received intravitreal Bevacizumab injection at presentation. Optical coherence tomography, visual acuity, and microperimetry were repeated after 7-10 days of treatment to evaluate the correlation between functional and structural changes secondary to macular edema. Results: In this prospective study, 63 eyes were evaluated. Univariate analysis demonstrated that the initial visual Saudi Ophthalmology 2016: Program and Abstracts 49 acuity at presentation had no impact on the fixation stability (P=0.859).Fixation stability on microperimetry was worse significantly associated with the unstable fixation (P=0.033).Unlike central macular thickness, presence of subretinal fluid had a significant impact on fixation stability (P=0.007). Univariate analysis demonstrated a significant positive association between mean sensitivity and nature of retinal vein occlusion (ischemic versus non-ischemic), in which ischemic type had significantly worse prognosis (p=0.001). Patients presented with subretinal fluid had a significant worse mean sensitivity (P=0.004).Mean sensitivity on microperimetry shown to be affected by duration of symptoms from onset, patients presented earlier than 14 days had significant higher mean sensitivity mean 4.2 (SD=2.8) than patients presented at 14 days or later 2.2 (SD=2.4) (P=0.005).In addition, for final visual acuity, the presence of subretinal fluid attained a statistical significant value toward a worse vision (p=0.001).In the analysis of optical coherence tomography and vision after Bevacizumab injection in eyes with interrupted inner-outer segment and presence of subretinal fluid were shown to be significantly associated with worse final visual acuity (p=0.001). After bevacizumab injection, significant improvement of visual acuity, mean sensitivity, central macular thickness, and subretinal fluid were noticed. Conclusions: At presentation, morphological changes secondary to macular edema was significantly correlated with functional changes. Intravitreal bevacizumab shown to be effective in treating macular edema based on structural and functional changes. Treatment by intravitreal bevacizumab injection should be initiated as early as possible to avoid irreversible structural and functional photoreceptors damage. Presumed Intraocular Tuberculous Uveitis in Tertiary Hospital in Riyadh Awad Al-Qarni Purpose: To define the clinical characteristics including macular edema, to assess the outcome of treatment, complications, and rate of recurrence in patients with presumed intraocular tuberculous uveitis. Methods: All patients diagnosed with presumed tuberculous uveitis at King Abdulaziz University Hospital between January 1996 and March 2013 were reviewed. The 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 PPD, and response to antituberculous therapy. Results: Ninety one patients (141 eyes) were identified. There were 43 males (47.3%) and 48 females (52.7%) with a mean age of 48.2 years (±14.4) (range 18 -80 years). Seventy nine eyes (56%) had panuveitis and thirty four eyes (24.1%) had posterior uveitis at presentation. Macular edema presented in 33.3% of eyes with highest incidence in intermediate uveitis group (61.1%). All patients received antituberculous therapy and systemic systemic corticosteroid s. After a mean follow-up of 36 months (±2.5) all eyes showed resolution of inflammation, associated with significant improvement in visual acuity (VA) (P =0.003) , with only 2 eyes with recurrences. There was a significant positive correlation between initial and final VAs (P<0.001). Forty seven eyes with macular edema were examined at baseline and at follow-up with OCT. At final follow-up, there was a significant reduction in CMT associated with a significant improvement in VA . Conclusions: Treatment with antituberculous therapy combined with systemic systemic corticosteroidinduced resolution of inflammation with very low incidence of recurrences and associated with a significant improvement in visual acuity (20/40 or better vision in 56.7%). 50 Saudi Ophthalmology 2016: Program and Abstracts Thursday, March 10 Th1A – Free Paper Troubles from Trichomegaly of The Eyelashes: A Case Report of Erlotinib Induced Trichomegaly Mohammed YH Shaikh Purpose: Trichomegaly of the eyelashes is an uncommon side effect of epidermal growth factor receptor inhibitor therapy which is increasingly used in wide variety of cancers. The purpose of this case presentation is to highlight occurrence and implications of erlotinib induced trichomegaly and review the pertinent literature. Method: Case Report: A 65-year-old lady with unremarkable systemic history had been for about 7-years on topical dorzolamide/timolol eyedrops for stable glaucoma. She never had used any prostaglandin analogues. On her routine six monthly follow up she reported excessive growth of eyelashes which significantly interfered with her ability to instill drops correctly in her eyes, also caused physical obscuring of vision and bothered her with spectacle wear from eyelashes rubbing the lenses. Examination revealed long, dark, thick curly eyelashes with intervening zones devoid of eyelashes. She admitted to having resorted to self-epilation to rid her difficulties from enlarged lashes. Systemic review of her history confirmed recent diagnosis of advanced metastatic breast disease and chemotherapy with erlotinib. She was happy to be managed by epilation of bothersome eyelashes allowing her ocular and visual comfort. Results: Simple management options such as trimming of lashes and epilation can spare the patient from significant cosmetic and functional effects of erlotinib induced eyelash trichomegaly. Conclusion: The recognition of this sporadically reported uncommon condition and its management is essential not only to ensure acceptable cosmesis and ocular comfort but also to prevent serious ocular surface complication in an otherwise already predisposed patient. Proper attention to the side- effects would remove any potential hindrance to the compliance to targeted chemotherapy. Blow in Orbital Fracture in Endoscopic Turbinate Surgery Alicia G. Ferreiro Objective: Orbital blow-in fracture type are characterized by the displacement of the bony structures into the orbital cavity, resulting in decreasing the volume of the orbit causing exophthalmos. Material: 54 years old male referred to oculoplastics with acute exophthalmos right eye (OD), ocular motility restriction in abduction and exotropia immediately after inferior turbinectomy surgery when extubating the patient with a big Valsalva Maneuveur. Ophthalmic exam revealed visual acuity 20/20 OD normal globe and restricted medial rectus right eye and exophthalmos OD 25. Computed tomography showed medial rectus damaged by a 2mm bone fragment. Orbital subconjuntival approach was done and the fragment was excised. Conclusions: We think fragments of the orbital medial wall were forced into the orbit by a sudden increase in pressure in the ethmoide sinus in this patient when extubated. Until our knowledge this is the first case described in the literature with blow-in and medial wall caused by Valasalva while extubated. Tuberculous Conjunctivitis in an Anophthalmic Socket Omar Abdulsalam Tuberculous conjunctivitis was not an uncommon condition before the early 20th century, and is nowadays a rare occurrence, especially in the developed countries. We report a 27 year-old Saudi woman who underwent enucleation of the right eye at the age of 20 following a penetrating eye injury. She had a history of miliary tuberculosis (TB) that was treated at the age of 22. She presented with chronic purulent discharge from her right anophthalmic socket for 2 months. Cultures for bacteria and fungi were sterile. There was no response to empirical topical antibiotics and steroids. Direct microscopic examination of conjunctival scrapings with Ziehl-Neelsen staining revealed no microorganSaudi Ophthalmology 2016: Program and Abstracts 51 isms. Histopathological examination revealed epitheloid granulomas. Polymerase chain reaction (PCR) was negative for Mycobacterium tuberculosis DNA. Tuberculous conjunctivitis was suspected from the history of miliary TB and presence of epitheloid granulomas. Definitive diagnosis was made after prompt resolution of the ocular signs with no recurrence only after systemic antituberculous therapy. Frontalis Sling Silicone Rod Open Crease vs Closed Stab Technique to Correct Severe Ptosis with Poor Levator Function Alicia G. Ferreiro Purpose: To compare outcomes of two techniques of frontalis sling suspension surgery using silicon rod to correct severe upper eyelid ptosis with poor levator muscle function. Methods: This was a retrospective, nonrandomized, clinical study. Medical records of patients undergoing frontalis sling suspension to correct severe ptosis between January 2008 and December 2011 were reviewed. Silicone rods were sutured to the tarsal plate through a lid crease incision (OM) or passed through stab incisions placed midway of the lid margin and upper tarsal border (CM). Data retrieved included age, gender, type of surgery, preoperative and postoperative margin reflex distance (MRD) and complications. Outcome was considered as success if MRD after surgery was ‘2 to 4’ score. If MRD at last follow up was better than before surgery, outcome was considered as success. Associated conditions and post-operative complications were also documented. Results: We studied 155 eyelids of 146 patients with ptosis (137 unilateral, nine bilateral). OM (n=60) and CM (n= 85) groups had median follow-up of 1.5 and 1.4 years respectively. The satisfactory grade of success rate (2<MRD>4mm) in OM group was 30 [50%, (95% CI 37.3 -66.7)] and in CM group, it was 44 [51.8% (95% CI 41.2-62.4)]. Improved MRD in last follow up was obtained in OM group was 61 [71.8%, (95% CI62.2 -81.3)] and in CM group, it was 45 [75% (95% CI64-86)]. There was no significant difference in success rate between the two methods (P = 0.4). The main complications were exposure keratitis, which was observed in 13% OM vs 12% CM and lash ptosis and lid crease abnormalities, noted only in CM group. Conclusions: Silicone frontalis sling have same success rates in OM and CM to correct upper severe lid ptosis with poor levator function but lash and crease abnormalities occurred just with CM technique. Blind Painful Eyes: What to Inject? – Comparative Study of Retrobulbar Injection of Ethanol versus Chlorpromazine Alicia G. Ferreiro Purpose: Chronic orbital pain arising from blind eyes often does not respond to conventional medical therapy. The use of retrobular injections with one of two agents were evaluated for efficacy and adverse events. Methods: In this prospective randomized clinical trial, Group 1 (GR-I) received 1.5 mm of absolute ethanol (alcohol) while Group 2 (GR-II) received 1.5 ml of chlorpromazine 25mg/ml for the retrobulbar injection. Verbal Numeric Visual Analogue Scale (VAS) was used to rank the pain before, during and after intervention. Intraocular pressures (IOP) and adverse events were recorded. Patients with no pain had complete success. Patients who went on to require evisceration or enucleation or who had no change in the ranking of the pain were termed as treatment failures. Results: GR-I and GR-II included 16 patients each. Complete success was achieved in 7/16 (43.7%) and 6/16 (37.5%) in GR-I/ GR-II respectively. Failure rate was 5/16 (31.3%) and 6/16 (37.5%). Postoperative adverse events were seen in 33.3% G-I and 56% G-II. Most pronounced was the eyelid edema seen with G-II. IOP reduction was seen in both groups. While the mean IOP was higher at entry with the chlorpromazine group (24.3 mmHg versus 14 mmHg with GI,) the exit IOP was lower for this group as well (15 mmHg versus 18.8mmHg G-I.) None of the patients had interventions to decrease IOP after the injections. All patients with IOP over 27 mmHg had pain scores of over 5 initially. Five of the seven (71.4%%) patients with initial IOP over 45mmHg had severe pain. After injection, only one person (1/4) with an IOP over 27mmHG had more than minimal pain. Conclusions: Both retrobulbar alcohol and chlorpromazine injections had similar results in relieving pain. The injections did provide pain relief, but approximately 1/3 did continue to have enough pain requiring reinjections or enucleation/evisceration. Both injections had few postoperative complications and all resolved. Decreased IOP and reduction of pain occurred after either injection for two-thirds of blind painful eyes. 52 Saudi Ophthalmology 2016: Program and Abstracts Orbital Lymphoma Behaves as Subperiosteal Mass Abdulrahman F. Al-Bloushi We report atypical location of orbital lymphoma in 57-year-old male patient who is known to have type 2 diabetes mellitus and essential hypertension present with progressive left eye proptosis over 5 years period. Orbital computed tomography was performed at presentation and showed bilateral orbital roof subperiosteal masses and causing mild proptosis. Incisional biopsy performed which revealed Non-Hodgkin’s extranodal marginal B cell (MALT) lymphoma. Localized Orbital Amyloidosis: Case Report Laila S. Al-Ghaferi Aims/background: Localized amyloidosis is rarely encountered in the orbit. The typical clinical and radiological appearances have not been clearly established. The aim of this case report is to describe one case of a rare orbital disease and to present the clinical features, radiological and histopathological findings of localized orbital amyloidosis. Material and methods: The clinical features, radiological findings, and histopathology findings of one patient with localized orbital amyloidosis were described here. Conclusion: Localized orbital amyloidosis may present with a wide spectrum of clinical findings and result in significant ocular morbidity. The goal of the treatment is to preserve function and to prevent sight threatening complications. Skin Wrapped Conformer Over a Temporalis Muscle Transfer to Reconstruct Severely Contracted Socket Omar BenHusain Objective: To report a successful socket reconstruction technique consisting in temporalis muscle transfer with skin graft wrapped conformer in 3 severely contracted anophthalmic socket. Case Report. Three severely contracted sockets (grade 4) unable to hold the cosmetic prosthesis. Previously, they had unsuccessful multiple surgeries with mucosal grafting and orbital implants. Surgical technique: temporalis muscle transfer was done through a lateral orbitotomy, all cicatricial tissue within the socket was excised, and the skin graft wrapped conformer was sutured at its mid-periphery to the inferior and superior orbital rim. Then second surgery was done to open the skin bag horizontally and reform the lids margins. One year of follow-up showed that the three of them were able to hold their external prosthesis. Conclusions: A successfully rehabilitated anophthalmic socket must hold and support a prosthetic device that mimics the contralateral globe. The goal is symmetry. The static symmetry of the palpebral apertures, canthal angles, and superior sulci are basic objectives. Adequate lid levels and contours and sufficiently deep conjunctival fornices are necessary to keep the prosthesis in place. Temporalis muscle flap transfer provides a well-vascularized bed for delayed or at the same time reconstructions with skin bag shaped graft. This technique represents an effective approach to successfully reconstruct and maintain stable ocular cul-de-sacs in cases of severe socket contracture or total symblepharon formation. Eye Diseases Due to/and Treated by Hyperbaric Oxygen Therapy Medhat M. Eldakhakhny Hyperbaric Oxygen Therapy (HBOT) is an evolving treatment modality. It is well known to affect the eye either temporarily by inducing temporary reversible myopia or it might accelerate the maturation of nuclear cataract. Conversely, it has been approved for treatment of central retinal artery occlusion with restoration of vision in the majority of cases if applied early. Other eye indications are treated off guidelines pending approval or refutation by relevant scientific hyperbaric associations. Review of HBOT with its utilities and implications in eye disease will be presented. Saudi Ophthalmology 2016: Program and Abstracts 53 Perceptions and Career Expectation in Ophthalmology among Saudi Undergraduate Medical Students Majid B. Abalkhail Purpose: To assess perceptions about ophthalmology, as a career, and determinants of career choice in ophthalmology among undergraduate medical students. Method: A questionnaire was administered to all medical students in 4th, 5th and 6th year and interns. The questionnaire investigated demographic and academic data, factors influencing career choice, perception about ophthalmology as a career and as a field, experience in ophthalmology and impact of ophthalmology rotation on the student’s perception. Results: We recruited 519 (61.3% females) students, distributed as 37.4%, 31.0% and 22.0% in 4th, 5th and 6th year respectively, and 8.9% interns. Ophthalmology appeared in 29 (5.6%) cases as the first choice; and in 70 (13.5%) cases in the top three choices. Comparison between students who aspire for ophthalmology as a career (group A) and those who do not (group B) showed a female proportion of 72.9% versus 55.6%, respectively, (p=0.009); and a comparable distribution in grade. Analysis of career choice determinants showed more consideration for workload during residency (80.0% versus 65.6%, p=0.021) and less for the following factors: challenging intellectual features (58.0% versus 78.7%, p<0.001); challenging instrumental features (62.3% versus 78.3%, p=0.007) and possibility to work in urban settings (46.4% versus 59.8%, p=0.045), in group A versus group B, respectively. Analysis of the experience in ophthalmology showed more attendance/participations in conferences (p<0.001), research (p<0.001) and community services related to ophthalmology (p<0.001) in group A versus group B. Further, the ophthalmology rotation had higher impact in scientific curiosity (p=0.002) and interest about ophthalmology (p<0.001) in students from group A. Conclusion: Students aspiring for a career in ophthalmology display earlier engagement in related academic activities and have less concern about related instrumental and intellectual challenges, in comparison with their peers. The ophthalmology rotation may constitute a key-step to enhance the student’s predilection to the specialty. General counseling in late clinical years is crucial in determining career specialty choice, specific counseling related to different specialties should be encouraged as well. Assessment of Awareness of Patients’ Rights and Attitude toward Ophthalmology Residents in University of Dammam (Ophthalmology Department) Abdulaziz H. Al-Dhafeeri Background: General awareness of human rights has been on the rise recently. Cultural differences play an important role in individuals’ attitudes and perception of rights in general and their rights as patients in particular. In the time being and with the evolution of medical practice, its has become essential for patients to understand their rights clearly, and be able to incorporate these rights in choosing the optimal treatment plan along with their treating physician. It is also important to post resident physician in evaluating the patient’s condition and to take the appropriate management plan is one of the basics of learning in their respective fields, and that’s will not incompatible with the rights of the patient. Method: Cross-sectional descriptive design using paper questionnaires in Arabic language to assess the awareness of patients’ rights and patient attitude toward medical ophthalmology residents. In order to collect the data questionnaires were handed to a sample size of 613 individuals both males and females, all were patients in the out-patient clinics of ophthalmology department in King Fahad Hospital of the University. Participants were all informed that the data will be anonymous and confidential, and the consent was verbally taken. Data entry and data analysis were done using SPSS statistical software package. Results: Knowledge of patient rights among the sample was 72.21% and the most scoring source of information was social media by a percent of 49.27. The most scoring question was question number 3 in the data sheet (do you know that you have the right to be provided with appropriate medical services available in hospital facilities regardless of your ethnicity, religion, believes, doctrine, language, sex, age, or disability?) by 85.64% and the least scoring question was question number 7 in the data sheet (Do you know that you have the right to be provided with interpreters to communicate with health care staff?) by 55.63%. The most scored source of information was social media as a resource of information accounting for 49.59% and the least scored source of information was nursing staff accounting for 11.75%. There is a direct proportion between knowledge of patient rights with their education level and with the use of social media as a resource of information. Patients with advanced level of academic education have the highest score of knowledge of their rights by a percent of 74.5% and the usage of social media as a resource of their informa54 Saudi Ophthalmology 2016: Program and Abstracts tion accounts for 62.5%. The study also revealed that the illiterate patients have the lowest score of knowing their rights at a percent of 60.95 and their use of social media as a resource of information was by 14.29%. High experience resident with supervision of ophthalmologist is the most scoring in all attribute of involvement of residents as well as having the least rejection, on examination; 53.34% of patients would like to be examined, 40.29% do not mind and 6.36% wouldn’t like. On management 46.17% of patients would like to be managed, 45.51% do not mind and 8.32% wouldn’t like. On simple surgical procedure 36.54% of patients would like to undergo a procedure performed by the resident physician, 51.06% do not mind and 12.4% wouldn’t like. On intermediately difficult procedure 31.48% would like to undergo the procedure, 52.37% do not mind and 16.15% wouldn’t like. On difficult procedure 28.38% would like to undergo the procedure, 43.32% do not mind, and 28.38% wouldn’t like. Patients’ knowledge of their rights contributes to the involvement of residence & show low rejection. Low experience resident with supervision of ophthalmologist, Intermediate experience resident with supervision of ophthalmologist & high experience resident without supervision of ophthalmologist shows inverse proportion to the patients knowledge of their rights & patients rejection to the involvement of the residents in examination & management. Conclusion: Patients have good knowledge about their rights. The study shows direct proportion between knowledge of patient rights with their education level & the use of social media as a resource of information. As to the action involving (management plans, and procedures) patients tend to reject the involvement of residents regardless how experience they are and whether they are supervised by ophthalmologist or not. However, residents supervised by ophthalmologist having less rejection comparing with residents that are not supervised by ophthalmologist. Patients who have high knowledge of their rights contribute to the involvement of residence & show low rejection. Th1B – Retina Diabetic Retinopathy: Knowledge, Awareness and Practices of Physicians in Primary-care Centers in Riyadh, Saudi Arabia Raghad Al-Rasheed Purpose: To evaluate the current knowledge, awareness, and to assess practices among primary care physicians working in primary care centers in Riyadh, regarding Diabetic Retinopathy (DR). Method: We conducted a cross-sectional study covering 46 Ministry of Health primary care centers in Riyadh, Saudi Arabia during October 2015. A Self-administered questionnaire was distributed to primary care physicians containing 3 main sections. The first section focused on participants’ demographics and professional background. The second section contained multiple-choice questions on knowledge related to diabetes and DR. A Score of one was given for each correct answer and zero for the wrong or did not know answers. The last section was to assess physicians’ practices. Data was analyzed using SPSS version 21. Results: A total of 216 general physicians completed the questionnaire. The mean overall knowledge score for all the respondents was 57±14 out of 100. Knowledge was significantly higher for physicians with >15 years of practice (59±13 vs. 54±15, P=0.04). Male physicians scored better than females, 13% vs. 6.7% respectively scored >75. A defect was noticed in area of screening and follow-up of type 1 diabetes, only 24% of physicians correctly referred patients with type 1 diabetes to an ophthalmologist, whereas 71% referred patients with type 2 diabetes as recommended by the guidelines. Another defect area was detected in treatment options. Majority agreed on the use of laser photocoagulation as treatment. However, only 1/5 of participants were aware of the use of steroids and anti-VEGF as possible options. 65% of physicians claimed the capability of using an ophthalmoscope, 74% of them have examined their patients with it. Conclusion: Our study uncovered areas of defects in knowledge among general practitioners regarding diabetes and DR. Therefore, future seminars on diabetes emphasizing the proper ophthalmological screening and management of patients are necessary. Saudi Ophthalmology 2016: Program and Abstracts 55 Atypical Finding of Idiopathic Macular Telangiectasia Type 2 with Peripheral Vascular Anomaly Saba Al-Rashaed Purpose: To report a case of Idiopathic macular telangiectasia that had peripheral angiographic vascular anomaly. Background: Macular telangiectasia type 2also known as idiopathic perifoveal telangiectasia and juxtafoveolar retinal telangiectasis type 2A or Mac Tel 2 is an acquired bilateral neurodegenerative macular disease that usually manifests itself during the fourth to sixth decades of life and is characterized by minimal dilatation of the parafoveal capillaries with graying of the retinal area involved, a lack of lipid exudation, right-angled retinal venules, refractile deposits in the superficial retina, hyperplasia of the retinal pigment epithelium, foveal atrophy, and subretinal neovascularization (SRNV). Optical coherence tomography images typically demonstrate intraretinal hyporeflective spaces that are usually not related to retinal thickening or fluorescein leakage. The typical fluorescein angiographic finding is a deep intraretinal hyperfluorescent leakage in the temporal parafoveal area. With time the leakage may involve the whole parafovea, but does not extend to the center of the fovea. We are reporting case of or Mac Tel 2 that demonstrated angiographic peripheral vascular anomaly that was not reported prevouisly. Methods: Patient data including clinical examination fundus photos, OCT and (intravenous fluorescein angiography) IVFA findings were reviewed. Case report: 69 years old otherwise healthy women Presented with visual impairment since 6 months. Visual acuity in right eye OD was 20/50 in left eye OS WAS 20/80. Anterior segment examination was unremarkable. Dilated fundus examination in both eyes revealed loss of retinal transparency in the perifoveal region, dilation of the parafoveal capillaries mainly in the temporal parafoveal area, Crystalline deposits at the vitreoretinal interface,right angle Blunted, dilated retinal venules and RPE hyperplasia.Fundus autofluorescence showed the loss of the normal hypofluorescent center. OCT showed an asymmetric foveal pit with the temporal area being thinner than the nasal and hyporeflective cavities in the inner and outer neurosensory retina. hyperreflective intraretinal lesions with posterior shadowing corresponds to foci of retinal pigment hyperplasia .60 degree field IVFA demonstrated parafoveal telangiectactic capillaries which was predominantly temporal to the fovea. wide field angiography (optos) demonstrated prominent retina telangiectasia at the peripheral with mild leak. Based on the clinical and retinal images findings the case was diagnosed as Mac tal type 2 with unusual angiographic peripheral vascular telangiectasia Conclusion: This study represents the first reported two cases of Idiopathic macular telangiectasia type 2 with proven angiographic peripheral vascular anomaly. This finding may shed light on the possibility of this disease entity had wider spectrum of vascular changes that might contribute to the pathogenesis of this condition therefore we recommend to consider examination the peripheral retina vasculature to detect any subtitle vascular anomaly Purtscher-like Retinopathy as a First Manifestation of Systemic Lupus Erythematosus Reem Al-Ahmadi Purpose: To report a case of bilateral Purtscher-like retinopathy in a female patient as a first presenting sign which led to the diagnosis of systemic lupus erythematosus (SLE). Case presentation: An otherwise healthy 21-year old female presented with bilateral rapid decrease in vision for one month. Fundus examination revealed multiple cotton wool spots and flame-shaped hemorrhages in both eyes. Optical coherence tomography displayed severe macular edema. Fundus fluorescein angiography showed multiple retinal arteriolar occlusions. Rheumatology was consulted for investigation. Work up for the patient confirmed the diagnosis of SLE. She was diagnosed with SLE and subsequently treated with corticosteroids and immunosuppressive medication. Conclusion: Although vaso-occlusive retinopathy is a rare presentation of SLE, it is important to suspect the diagnosis of SLE in a patient with such presentation, in order to promptly initiate proper treatment. Rare Presentation of Dome-Shaped Maculain Saudi Patient Adel Al-Akeely Dome-shaped macula (DSM) was first described by Gaucher et al as a convex protrusion of macula within a staphyloma in highly myopic eyes that causes visual impairment associated with serous foveal detachment (SFD). We de56 Saudi Ophthalmology 2016: Program and Abstracts scribe a patient with persistent SFD in DSM documented by serial spectral domain optical coherence tomography (SD-OCT) for 6 years with stable vision. Ocular Injuries Secondary to Alexandrite Laser-Assisted Hair Removal Mohammed Asiri Purpose: To describe the clinical manifestations and outcome of three patients who sustained eye injury during Alexandrite laser assisted hair removal. Methods: A retrospective case series of 3 patients. Data were collected on ophthalmic examination, spectral domain optical coherence tomography (SD-OCT) and fundus fluorescein angiography (FFA). Results: Three female patients sustained injury due to Alexandrite laser hair removal. One patient presented with acute anterior uveitis while the other two patients presented with foveal intraretinal hemorrhage and subfoveal choroidal neovascularization, respectively. Visual acuity at last follow up ranged from 20/15 to 20/20. Conclusion: Laser-assisted hair removal may lead to various forms of ocular injuries if used improperly. Ophthalmologists should be aware of the ocular damage caused by these laser devices. T-shaped Macula Buckling Combined with Pars Plana Vitrectomy for Macular Hole, Macular Schisis and Macular Detachment Marco Mura Purpose: To report our experience using the T-shaped macular buckle (MB) with or without pars plana vitrectomy (PPV) as a primary surgery or with a previous failed surgical approach in patients affected by high myopia and macular hole (MH) with or without macular detachment (MD) and with or without macular schisis (MS). The primary goal was to evaluate complete closure of the MH and reattachment of the retina. Methods: Retrospective case series of 21 consecutive patients who underwent T-shaped MB implant alone or combined with PPV at the Academic Medical Center in Amsterdam, The Netherlands, between January 2013 and November 2014. The mean axial length was 31,22 mm . The mean follow up period was 7 months. Results: Retinal reattachment was achieved in 100% of cases while MH closure was achieved in 90.5%. No major perioperative complications were observed. BCVA improved in 71.4% of patients. Conclusion: MB combined with PPV should be considered as the preferred surgical approach both in primary and recurrent retinal detachment secondary to MH in high myopic eyes. Retinopathy of Prematurity (RoP) Prevalence and Risk Factors in King Abdulaziz Medical City (KAMC) in Riyadh Bader Al-Qahtani Background: Retinopathy of prematurity (ROP) is an eye disease that affect premature infants. A small gestational age, low birth weight and high oxygen therapy considered as risk factors for ROP. It is one of the common causes of childhood blindness unless treated appropriately. Objective: The aim of this project was to determine the prevalence of ROP in preterm infants in the Neonatal Intensive Care Unit, to identify the risk factors that predispose to ROP and to assess the outcome of those infants. Methods: This was a retrospective cohort study of premature infants with birth weight of =1500 grams or gestational age of =32 weeks. Those infants were admitted to NICU of King Abdul-Aziz Medical City in Riyadh between January 2010 to December 2014. The demographic data, perinatal risk factors for ROP and outcomes of those patients were assessed and analyzed by SPSS. Results: Five hundred and ninety three infants were included in this study. Out of those, 224 infants (37.8%) had ROP. A percentage of 11.1% of those infants had stage 3, which means a severe ROP disease. The mean body weight of infants with ROP was 983 g and the mean gestational age at birth was 27 weeks. A significant relationship with a pvalue <0.05 has been found between the occurrence of ROP and small gestational age at birth, low birth weight, low Saudi Ophthalmology 2016: Program and Abstracts 57 APGAR score at 1 minute and long duration of receiving O2 therapy. Among those infants with ROP, 3 infants had Laser treatment and 14 had Anti-VEGF. Based on charts review, no one of those infants had blindness. Conclusion: The prevalence of ROP in our study beside other local studies fall in the range of the disease prevalence in the developing countries. It is recommended to control the duration of oxygen therapy. Incidence of Retinal Detachment in Patients with Bechet’s Disease Samir S. Shoughy Purpose: To determine the incidence of retinal detachment (RD) in patients with Behcet’s disease. Methods: We included a total of 47 consecutive patients with Behcet’s disease. Patient charts were reviewed to detect RD and predisposing retinal lesions. Results: There were 45 male and 2 female patients with a mean age o 28 years. RD occurred in 7 (15%) patients. Two patients had predisposing retinal tears and 2 patients had macular holes. One patient had intravitreal injection 8 weeks prior to development of RD. Conclusion: RD should be kept in mind in patients with Behcet’s disease. Careful examination should be carried out to in patients who receive intravitral injections and to detect predisposing retinal tears or macular holes. Th2A – Free Paper Safety and Efficacy Comparison between Brand-name and Localy Manufactured Generic Fixed Combination of 2% Dorzolamide/0.5% Timolol Leyla AA Al-Jasim Purpose: To compare the available 2%Dorzolamide/0.5% Timolol fixed combination; the brand name Cosopt and localy manifactured Xolamol. Method: Double blinded clinical trial, 28 patients were on fixed combination Dorzolamid/Timolol, after wash out, started on one drug for 6 weeks, then crossed over to the other; IOP levels, signs, symptoms and patient satisfaction were monitored Result: After wash out IOP was 19.5mmHg in first group; patient started on Cosopt IOP at 6 weeks 14.5, then crossed over to Xolamol, IOP at 6 weeks 14.9 the other group IOP after washout 18.8, started Xolamol, IOP at 6 weeks 15, crossed to Cosopt, IOP 13.6 after 6 weeks conjunctival injection increased with the use of Xolamol compared with Cosopt use Patient satisfaction was high in use of both drugs. In view of small sample the difference in satisfaction rate among two groups was not statistically significant. Conclusion: No apparent difference in decline of IOP by both drugs. Elevated Intraocular Pressure Increases Melatonin Levels in The Aqueous Humour Hanan A. Al-Kozi Purpose: To study the levels of melatonin in the aqueous humour of normotensive and hypertensive IOP patients and to compare them in an animal model of glaucoma. Methods: 37 eyes of 37 patients who underwent cataract surgery were included in the study and were divided into normotensive patients, with IOP below 21 mmHg (n=23) and hypertensive patients, with IOP > 21 mm Hg (n=14). Glaucomatous DBA/2J (n=6) and control C57BL/6J (n=6) mice presenting 3 and 15 months of age for each strain were also used. Human and mice aqueous humours were aspirated using a 30-gauge Rycrof cannula on a tuberculin syringe and further processed to quantify melatonin by HPLC analysis. Results: Melatonin levels in normotensive patients (IOP below 21 mm Hg) presented values of 33.14 ± 11.61 ng/mL (n=23), while hypertensive patients (IOP above 21 mm Hg) showed melatonin concentrations of 95.87 ± 28.23 ng/mL (n=14) (p<0.039). Glaucoma mice presented melatonin values of 0.44 ± 0.06 ng/mL (at 3 months of age, before the pathology starts) which raised to 1.45 ± 0.18 ng/mL (at 15 months of age, when the pathology is fully established and 58 Saudi Ophthalmology 2016: Program and Abstracts IOP is maximum) (n= 6, p<0.001). Control mice did not significantly modified melatonin concentrations between 3 and 15 months of age. Conclusion: Glaucoma patients with high IOP present increased concentrations of melatonin in their aqueous humour compared to normotensive patients. This has been confirmed in a glaucomatous animal model in which it has been possible to see a correlation between the development of the pathology, with an increase in IOP, and a concomitant elevation of melatonin in the aqueous humour. Bottle Characteristics of Topical International Glaucoma Medications versus Local brands in Saudi Arabia Reham D. Al-Qahtani, What is known and Objective: Physical bottle characteristics differ of brand name topical glaucoma medications and local generic equivalents. This study compares the bottle characteristics of international topical glaucoma brands versus local brands from the Kingdom of Saudi Arabia (KSA). Methods: Data were collected on bottle drum volume, drop volume, bottle ‘squeezability’, bottle tip diameter, labels and instructions, cap color coding and clarity of the drug label. Density-based calculations of drops in bottle volume were assessed using an analytic balance. Bottle tip diameter was measured using 0.05 mm Vernier calipers. A Likert scale based questionnaire was used to assess the subjective opinions of patients on bottle squeezability, clarity of usage and storage instructions and the consistency of the cap color coding. Results: The volumes of international brands were statistically significantly higher than the local brands (p<0.001). The number of drops per bottle and tip diameter were comparable between international local brands. Cap color coding was inconsistent for international and local brands. Patients were dissatisfied with the label font size. Patients reported that the international and local brands were similar in terms of the ease of opening the bottle, instilling a drop and the clarity of the instructions; but the local brands were subjectively easier to squeeze than international brands. What is new and Conclusions: This is the first study to compare bottle characteristics of local Saudi Arabia brands with international brands. The bottle characteristics and patient feedback were similar between local and international topical glaucoma medications. However, there were differences between the local and international brands in drug volume, bottle squeezability. Hence patient compliance and drop dosage may differ based on the origin of manufacture. Histopathologic and Immunohistochemical Features of Capsular Tissue Around Failed Ahmed Glaucoma Valves Alka M Mahale Purpose: Impervious encapsulation around Ahmed glaucoma valve (AGV) results in surgical failure raising intraocular pressure (IOP). Dysregulation of extracellular matrix (ECM) molecules and cellular factors might contribute to increased hydraulic resistance to aqueous drainage. Therefore, we examined these molecules in failed AGV capsular tissue. Methods: Immunostaining for ECM molecules (collagen I, collagen III, decorin, lumican, chondroitin sulfate, aggrecan and keratan sulfate) and cellular factors (aSMA and TGFß) was performed on excised capsules from failed AGVs and control tenon’s tissue. Staining intensity of ECM molecules was assessed using Image J. Cellular factors were assessed based on positive cell counts. Results: Histopathologically two distinct layers were visible in capsules. The inner layer (proximal to the AGV) showed significant decrease in most ECM molecules compared to outer layer. Furthermore, collagen III (p=0.004), decorin (p=0.02), lumican (p=0.01) and chondroitin sulfate (p=0.02) was significantly less in inner layer compared to tenon’s tissue. Outer layer labelling however was similar to control tenon’s for most ECM molecules. Significantly increased cellular expression of aSMA (p=0.02) and TGFß (p=0.008) was detected within capsular tissue compared to controls. Conclusion: Our results suggest profibrotic activity indicated by increased aSMA and TGFß expression and decreased expression of proteoglycan (decorin and lumican) and glycosaminoglycans (chondroitin sulfate), which further stimulates TGFß signalling. Additionally, decreased collagen III coupled with increased TGFß and aSMA is also linked to increased myofibroblast contractility. Together these events lead to tissue dysfunction potentially resulting in hydraulic resistance that may affect aqueous flow through the capsular wall. Saudi Ophthalmology 2016: Program and Abstracts 59 Diagnostic Accuracy of Spectral Domain Optical Coherence Tomography and Scanning Laser Tomography for Identifying Glaucoma in Myopic Eyes Rizwan Malik, Anne C. Belliveau, Glen P. Sharpe, Lesya M. Shuba, Balwantray C. Chauhan, Marcelo T. Nicolela Purpose: Ruling out glaucoma in myopic eyes often poses a diagnostic challenge because of atypical optic disc morphology and visual field defects that can mimic glaucoma. We determined whether neuroretinal rim assessment based on Bruch’s membrane opening (BMO), rather than conventional optic disc margin (DM)-based assessment or retinal nerve fiber layer (RNFL) thickness yielded higher diagnostic accuracy in myopic glaucoma patients. Methods: Case-control, cross sectional study with myopic glaucoma patients (n=56) and myopic normal controls (n=74). Myopic subjects with refraction error greater than -2 D (spherical equivalent) and typical myopic optic disc morphology, with and without glaucoma, were recruited from a glaucoma clinic and a local optometry practice. The final classification of ‘myopic glaucoma’ or ‘myopic control’ was based on consensus assessment by 3 clinicians of visual fields and optic disc photographs. Participants underwent imaging with confocal scanning laser tomography for measurement of DM rim area (DM-RA) and with spectral domain optical coherence tomography (SD-OCT) for quantification of a BMO based neuroretinal rim parameter, minimum rim width (BMO-MRW) and RNFL thickness. Sensitivity of DM-RA, BMO-MRW and RNFL thickness at a fixed specificity of 90% and partial area under receiver operator characteristic (ROC) curves for global and sectoral parameters for specificities = 90% (pAUC) were the main outcome measures. Results: Sensitivities at 90% specificity were 30% for DM-RA, and 71% for both BMO-MRW and RNFLT. The pAUC was higher for the BMO-MRW compared to DM-RA (p<0.001), but similar to RNFL thickness (p>0.5). Sectoral values of BMO-MRW tended to have a higher, but non-significant, pAUC across all sectors compared to RNFL thickness. Conclusions: BMO-MRW is more sensitive than DM-RA and similar to RNFL thickness for the identification of glaucoma in myopic eyes and offers a valuable diagnostic tool for glaucoma patients with myopic optic discs. Ergonomic in Preventing Work-related Musculoskeletal Disorders in Ophthalmic Practice Waleed A. Al-Rashed Purpose: To increase the awareness of eye health care providers about work-related musculoskeletal disorders. Method: Literatures review of all aspect of work related musculoskeletal disorders pertaining to eye care providers. Results: Work related Musculoskeletal disorders (WRMSDs) among health care workers including Physicians, Registered nurses, dental hygienist, and Custodial worker are well known. It has being noticed anecdotally and recently substantiated by different studies an increase in the prevalence of WRMSDs on the above mention groups. Ophthalmologist in particular along with dentist and other surgical specialties (Laparoscope surgeon) are at even high risk of developing WRMSDs. This was attributed to the nature of the job with prolonged awkward position and repetition. This poster will try to highlight the most important areas where health care providers especially the ophthalmologist should take care and aware of to prevent or at least reduce the WRMSDs. In different areas of work including: A) In the clinic: The proper way of sitting and conducting slit lamp examination with or without the uses of different lenses. How to perform indirect ophthalmoscope with the least stressful way to cervical and lumbar spine. B) In the work station: How to select ergonomic and comfortable chair, tables, mouse, keyboard, screen and foot rest. c) In the operating room: Tips in how to adjust surgeon chair, microscope, and operating table. Also hint in the proper way to select and use of surgical loop. High quality illustrations and photos will be included to help better understanding the massages. Conclusion: Adopting a healthy posture and good basic ergonomics habit in different areas of ophthalmic works early in the medical career and maintain regular exercise will reduce those unwanted Musculoskeletal squeals and hopefully leading to prolonged most productive healthy career life. 60 Saudi Ophthalmology 2016: Program and Abstracts Genetics of Congenital Glaucoma in Saudi Arabia, Phenotype-Genotype Correlation Leen J.Abu Safieh Purpose: Primary congenital glaucoma (PCG) is an autosomal recessive disorder, affects children between birth and 3 years old and cases improper development of the eye’s aqueous outflow system that results in optic nerve damage and significant vision loss. PCG is predominantly caused by mutations in the CYP1B1 gene. The aim of the study is to understand more about the genetic/environmental factors verse the phonotypic presentation that affect the development and course of PCG in Saudi patients which will eventually help in diagnosis and patients care. PCG is more common in Saudi Arabia than many other parts of the world. To date 3 mutations has been reported to be the major cause of glaucoma in the Saudi population. Methods: In this study we screened our cohort 75 of PCG families at KKESH for the common CYP1B1 mutations. We collected blood and extracted DNA from affected individuals and available relatives. We performed PCR and direct sequence analysis to detect mutations and perform genotype/phenotype correlation. Results: In this study we identified one novel missense mutation to be responsible for disease in less than 1% of the cases, the previously reported p.G61E mutation is found to be responsible for approximately 40% of all cases, emphasizing on the founder effect expected from a consanguineous population like the Saudi population. Screening our cohort against the previously reported p.R469W mutation showed that it is responsible for approximately 1% of the cases. Approximately 34% were negative for mutations in CYP1B1, disease in these cases would be either due to regulatory or deep intronic mutations in the CYP1B1 gene or any of the other glaucoma known genes. Conclusion: These results along with the clinical evaluations are being used in genotype phenotype correlation and genetic counseling for family with PCG. We analyzed the age of onset, vision severity, myopia and other clinical features and found significant different between the 3 mutations group. Th2B – Optometry – Color Vision Color Vision Processing in the Visual System: Retina to Cortex Michael Kalloniatis This is the introductory lecture for the series outlining the three fundamental discrimination functions: brightness, hue and saturation. These core discrimination functions will be discussed including the processing of color vision information in the visual system, prevalence of congenital color vision deficiencies and the design of color vision tests. Color Vision Testing Michael Kalloniatis The aim of this lecture is to review clinical color vision testing using pseudo-isochromatic plates like the Ishihara; sorting tests eg, Farnsworth panel D15, 100 hue and color matching tests like the Nagel as well as lantern tests used in some occupational testing. A scheme will be developed to allow discrimination of different types of congenital color vision deficiencies using a battery of color vision tests. Saudi Ophthalmology 2016: Program and Abstracts 61 Congenital and Acquired Color Vision Deficiencies Michael Kalloniatis The aim of this lecture is to provide strategies on testing for congenital and acquired color vision deficiencies in clinical practice. Various clinical color vision tests will be used to illustrate the different types of color vision deficiencies, including the application of Koellner’s rule to help differentiate the different types of acquired color vision deficiencies. Examples from clinical cases seen at the Centre will inform differential diagnosis of acquired color vision results. Giving Practical Advice Relating to Color Vision Results Michael Kalloniatis The lecture will focus on occupational standards and other advice optometrists can provide relating to color vision deficiencies or color vision aptitude. Examples will be provided where defective color vision has led to major accidents: both recent as well as a historical perspective. 62 Saudi Ophthalmology 2016: Program and Abstracts Poster Abstracts 1. Fungal Sclerokeratitis Salem Al-Malki, MD; Abdulrahman Gormallah Al-Malki, MBBS Inflammatory scleral disease is frequently associated with autoimmune disorders and only occasionally caused directly by an infective agent. Fungal infections primarily involving the sclera are rare, and the outcome is generally poor. Here we report patients with post-trumatic scleritis who was successfully managed by medical therapy. 2. Post BKpro Endophthalmitis in Steven Johnson Syndrome Patient due to Streptococcus Agalacticae Donald Stone, MD; Igor Kozak, MD; Omar Kirat, MD; Mohammad Ahmed Talea, MD; Humoud Mohammad Al-Otaibi, MBBS Purpose: To report undescribed case of Streptococcus agalacticae related endophtlamitis in a 25 years old male patient with Boston Keratoprosthesis due to severe corneal scarring in Steven Johnson syndrome. Methods: The patient was placed on fortified topical antibiotic regime, lunrication and systemic antibiotics. Then, was started on systemic corticosteroids after questionable choroidal detachment on B-scan ultrasound. After increase in ocular pain, intravitreal tap and injections of vancomysin and ceftazidin were performed. The pain subsided but the vision was the same two days post treatment. The vitreous culture showed b-hemolytic Streptococcus agalacticae with no fungal elements Results: On follow-up visit two weeks later, the patient improved after treatment and became pain free, vision improved to 20/200 and anterior segment was quiet. Conclusion: In patients with Boston KPro the risk to develop endophtlamitis due Streptococcus agalacticae was not described before. K-Pro surgery allows for visual recovery in patients who do not have other options for vision restoration. While advances have been made with prophylaxis, patients with K-Pro still maintain a lifetime risk of endophthalmitis. 3. Genetics of Congenital Glaucoma in Saudi Arabia, Phenotype-Genotype Correlation Leen Jameel Abu Safieh, PhD; Leyla Al Djasim, MD; Ohood Owaydha, MD; Deepak Edward, MD Purpose: Primary congenital glaucoma (PCG) is an autosomal recessive disorder, affects children between birth and 3 years old and cases improper development of the eye’s aqueous outflow system that results in optic nerve damage and significant vision loss. PCG is predominantly caused by mutations in the CYP1B1 gene. The aim of the study is to understand more about the genetic/environmental factors verse the phonotypic presentation that affect the development and course of PCG in Saudi patients which will eventually help in diagnosis and patients care. PCG is more common in Saudi Arabia than many other parts of the world. To date 3 mutations has been reported to be the major cause of glaucoma in the Saudi population. Methods: In this study we screened our cohort 75 of PCG families at KKESH for the common CYP1B1 mutations. We collected blood and extracted DNA from affected individuals and available relatives. We performed PCR and direct sequence analysis to detect mutations and perform genotype/phenotype correlation. Results: In this study we identified one novel missense mutation to be responsible for disease in less than 1% of the cases, the previously reported p.G61E mutation is found to be responsible for approximately 40% of all cases, emphasising on the founder effect expected from a consanguineous population like the Saudi population. Screening our cohort against the previously reported p.R469W mutation showed that it is responsible for approximately 1% of the cases. Approximately 34% were negative for mutations in CYP1B1, disease in these cases would be either due to regulatory or deep intronic mutations in the CYP1B1 gene or any of the other glaucoma known genes. Conclusion: These results along with the clinical evaluations are being used in genotype phenotype correlation Saudi Ophthalmology 2016: Program and Abstracts 63 and genetic counselling for family with PCG. We analysed the age of onset, vision severity, myopia and other clinical features and found significant different between the 3 mutations group. 4. Combined Central Retinal Artery Occlusion with Central Retinal Vein Occlusion after Blunt Trauma Mohammad Abdullah Al-Amry, MD; Hassan Al-Dhibi, MD; Sahar M ElKhamary, MD; Abdulrahman Al-Qaeed Purpose: To report a case of trauma to the Right eye while running and felled down on a sharp object. Method: Case report Result: A-20-year old male presented to the emergency room referred as a case of blunt trauma to his right eye. He lost the vision in that eye immediately. On examination the best corrected visual acuity was No Light Perception (NLP) right eye and 20/20 in the left eye. Intraocular pressure (IOP) was 7 mmhg in the right eye and 10 mmhg in the left. Lids and adnexa were normal with no proptosis or ptosis and the extra ocular movement showed full range of movement, conjunctival abrasion with sub conjunctival hemorrhage noticed, 2 conjunctival sutures was performed locally .cornea was clear and anterior chamber deep with occasional cells, pupil showed + 4 pupillary afferent defect (APD).lens was clear .The possibility of globe ruptured ruled out. Optic disc was swollen, hyperemic with picture of central retinal artery occlusion where retina background was pale with severe neurosensory retinal layer edema, associated with tortuous veins, clotted blood seen in the major veins, scattered retina hemorrhages going with the picture of central retina vein occlusion (Fig 1A-D). Intravenous Fluorescein Angiography (FFA) and Optical Computed Tomography (OCT) confirmed the occlusion of both central retinal artery and vein but normal choroidal fillings (Fig 2). The examination of the left eye was unremarkable. The impression was combined central artery occlusion associated with central vein occlusion. Compression of optic nerve (retrobulbar) to be ruled out. Computed Tomography CT scan was done to role out optic verve compression or optic Nerve avulsion but did not show any signs of Optic Neuropathy. Magnetic Resonance Imaging (MRI) was performed and showed diffuse thickening and near total effacement of the subarachnoid CSF space around the right optic nerve which appear markedly altered signal intensity with widening and broadening in the first few millimeters. Mild edamtous swelling related to levator paplpera superior complex and superior ophthalmic vein (Fig 2 a-f). Partial optic nerve avulsion was suggested. A week later was seen in neuro-ophthalmology and retina clinics with large angle exotropia. Global pallor with arterial attenuation and scattered retinal hemorrhages and both opinions agreed on the diagnosis of combined central retinal artery associated with central retinal vein occlusion 5. Signal Transducer and Activator of Transcription 3 Expression is Regulated by High-Mobility Group Box-1 Protein in Diabetic Retina Deema Essam Jomar, MBBS; Ghulam Mohammad, MD; Ahmed M. Abu El-Asrar, MD, PhD Purpose: The expression of high-mobility group box-1 (HMGB1) and signal transducer and activator of transcription 3 (STAT3) is upregulated in the diabetic retina. We hypothesized that the activation of STAT3 is under the control of HMGB1. Methods: Retinas from 1-month diabetic rats and from normal rats intravitreally injected with HMGB1 and retinal müller cells (MIO-M1) stimulated with HMGB1 or 30mM glucose were studied by Western blot analysis and immunofluorescence. We also studied the effect of the HMGB1 inhibitor glycyrrhizin on STAT3 translocation and diabetes-induced STAT3 expression in the retinas of rats (n=5-7 in each groups). Results: Treatment of retinal müller cells with recombinant HMGB1 induces nuclear translocation of STAT-3, but did not alter the STAT-3 expression. High gluocse induced significant upregulation of HMGB1 and STAT-3 in retinal müller cells and glycyrrhizin co-treatment normalized the HMGB1-induced upregulation of HMGB1 and STAT-3 expressions. Furthermore, our data show that intravitreal administration of HMGB1 in the vitreous of normal rats and diabetes increases STAT-3 expression. The HMGB-1 inhibitor GA attenuated diabetes-induced upregulation of STAT-3 in the retina. Conclusions: The results of this study suggested the role of HMGB-1 in the modulation of STAT-3 expression in the diabetic retina. 64 Saudi Ophthalmology 2016: Program and Abstracts 6. Late Onset Endophthalmitis Associated with Unexposed Glaucoma Valve Drainage Device Abdulaziz Al-Hadlaq, Salem Al-Malki, Sami Al-Shahwan Purpose: To report an extremely rare presentation of late-onset endophthalmitis in a patient with an unexposed Ahmed tube implant. Design: Retrospective case report. Methods: A young adult female presented with endophthalmitis associated with Ahmed tube implant. The implant was inserted 11 years prior to presentation. There was no history of trauma or any obvious exposure on clinical examination and the tube plate was filled with purulent material. Results: After aqueous and vitreous tap, the patient underwent intracameral, intravitreal subconjunctival antibiotic injections and was started on systemic antibiotics with good response. Conclusion: Endophthalmitis associated with tube drainage device can presents as late as 11 years and even without an unexposed tube. 7. Atypical Presentation of Cone-rod Dystrophy with Huge Bull’s Eye Maculopathy and Diffuse Vascular Leakage Hamad Mohammad Al-Sulaiman, MD; Sawsan R Nowilaty,MD; Patrik S Schatz, MD Purpose: Cone-rod dystrophies are characterized by primarily cone dysfunction/degeneration with associated rod dysfunction. Diffuse vascular leakage and huge bull’s eye maculopathy have not previously been reported in the context of cone rod dystrophy. Methods: Retrospective review of two male sibling’s KKESH records. Results: The two male siblings (26 year old and 16 year old) were diagnosed with con-rod dystrophy based on visual complaints, fundus appearance, autoflurescnce, and Full field electroretinography. Both carried huge bilateral hyperautofluorescent bull’s eye lesions covering the posterior poles. In addition, the eldest brother was found have para-arterial blockage of dye in the early and late phases of the FA with some subtle paravenous staining and vascular leakage throughout the retina all the way to the far periphery. He underwent Uveitis workup investigations in the form of CBC, ESR, CRP, LFT, ANA, Anti DS-DNA Antibody, calcium, Syphilis Serology, PPD testing, and chest x-ray and they were all within normal limits. Conclusion: To the best of our knowledge this diffuse vascular leakage without telangiectasia or exudation, and huge bull’s eye maculopathy has not been reported in association with cone rod dystrophy. 8. Retinal Complications After Anterior versus Posterior Chamber Phakic Intraocular Lens Implantation in a Myopic Cohort Abdulelah Abdulaziz Al-Abdullah, MD; Mohammad A. Al-Falah, MD; Saba A. Al-Rasheed, MD; Rajiv Khandekar, MD; Enrique Suarez, MD; J. Fernando Arevalo, MD Purpose: To compare the incidence and characteristics of retinal complications following implantation of two types of phakic intraocular lenses (PIOLs) in patients with myopia. Methods: In this comparative, retrospective study, 603 eyes of 344 patients with myopia underwent implantation of either an Artisan iris-fixated phakic intraocular lens IOL (Artisan; Ophtec, Groningen, Netherlands) (Artisan group) or a Visian implantable collamer lens (ICL; STAAR Surgical Company, Monrovia, CA) (ICL group) between June 2005 and December 2013. Preoperative, operative, and postoperative clinical data were collected on the incidence of retinal complications, including rhegmatogenous retinal detachment (RRD) or choroidal neovascular membrane (CNVM). Results: The Artisan lens was implanted in 185 (30.68%) eyes and 418 (69.32%) eyes underwent ICL implantation. Mean follow-up was 26.78 months (range: 9 days to 98 months). Mean preoperative spherical equivalent (SE) was -12.44 ± 4.43 D (range: -1.13 to -31.00 D). The overall rate of retinal complications was 1%. Postoperatively, 3 (0.7%) eyes developed RRD in the ICL group, and no eyes developed RRD in the Artisan group. Submacular hemorrhage was observed in 1 (0.24%) eye in the ICL group. Two (1%) eyes developed CNVM in Saudi Ophthalmology 2016: Program and Abstracts 65 the Artisan group. The mean time from PIOL implantation to retinal complications was 15.6 months (range: 0.03 to 43 months). Conclusions: Implantation of ICL or Artisan phakic IOL demonstrated comparable rates of retinal complications. Anterior chamber PIOL does not increase the risk of retinal detachment or CNVM in patients with myopia. 9. Acupuncture Treatment in Patients with Retinitis Pigmentosa, Tapetoretinalabiotrophy and Macular Dystrophy Md Anwarul Md Anwarul Azim, MD; Kuznetsova T.S, MD Background: Retinitis Pigmentosa,Tapetoretinal Abiotrophy and Macular Dystrophy are fairly common diseases, yet little is known about their causes and conventional treatment with surgery or drug are largely ineffective, it remains a major problem of modern ophthalmology. Objectives: To evaluate the effectiveness of acupuncture and bioresonance therapy (BRT) in patients with above mentioned diseases. Methods: In my Clinic Doctor Azim Ltd 17 patients, aged between 25-40 with retinitis pigmentosa, tapetoretinal abiotrophy of retina and macular dystrophy have been surveyed and passed the treatment by acupuncture and BRT. All treatments are carried out by me and consist of 10-12 sessions for 25-30 minutes each over 2-3 weeks. This is followed by continuous acupressure applied to some acupoints and bioresonance therapy (BRT) by fixed frequency waves (impulses), BRT along meridians (organs and systems) for one year supervision. Results: All patients regardless of their age noticed general somatic symptoms improvement, irritability decrease, sleep normalization, visual fatigue decrease. In all cases an increase of visual acuity from 10 up to 20%, near vision and visual field restoration were marked. Some subjective symptoms have also disappeared or have considerably reduced, enhanced clarity of vision, colors being brighter, better focus. The patients also noted significant downturn of light sensitivity in the macular part of retina threshold values. Clinical Examples: Patient aged 24; OE Vis: OD 0,01; OS 0, 2; IOP OU normal; DS. Abiotropy of retina, Retinopathy OU After Acupuncture treatment, BRT and Color therapy: Vis: OD 0,1 BCVA 0,3; OS 0,5 Case History: Patient aged 23; OE Vis: OD per L in certa; OS per L certa; IOP OU normal; DS: Retinitis Pigmentosa, Atrophy of Optic Neuropathy OU (after removing brain tumour) After Acupuncture treatment, BRT and Color therapy: Vis: OD 0,09; OS 0,04 After a second course of treatment (3 months later) Vis: OD 0,15; OS 0,05 Comments: The patient reported on almost immediate noticeable improvement in vision, specially near vision. Additionally, the patient reported on a significant decrease in her anxiety levels. She now enjoys a new sense of well-being after the treatment. Conclusions: Acupuncture and bioresonance therapy are highly effective non-medicamentous ways of treatment of these diseases. Acupuncture offers clear advantages and can be seen as a useful addition to standard treatment. By using these methods results in partial or full restoration of visual functions which is both effective and safe. In carrying out the above mentioned therapy adverse side effects and complications have not been revealed. 10. Effect of Vitamin Deficiency and Insufficiency on Patient with Diabetic Retinopathy Amjaad Hamad Al-Mohawis; Moutaz GUMA; Ahoud Al-Mutairi; Ghada Al-Duraye Purpose: The aim of this study is to explore the hypothesized effect of vitamin D deficiency on diabetic retinopathy severity. Methods: This observational cross-sectional study was conducted in KAMC, ophthalmology department, Riyadh, KSA. The subjects were randomly selected (n=159). Every Saudi patient with DRP and aged between 30 to 70 years old was included. A multinomial logistics regression model was used to examine if vitamin D is a significant predictor of progression of DR and Chi-square test. 66 Saudi Ophthalmology 2016: Program and Abstracts Results: There’s no significant relationship between DRP severity and vitamin D. The test revealed that the probability of the model chi-square was more than the level of significance (p<0.05). There is no significant relationship between DRP level and vitamin D. There’s no statistically significant relationship between DRP and gender (p=0.110) Conclusion: This study found no significant relationship between DRP severity and Vitamin D, which could be explained by the small number of patients. Propose that Prior studies suggesting the possibility of anti-inflammatory and antiangiogenic qualities of vitamin D. The relationship between vitamin D serum levels and DRP delegates further study. 11. Choroidal Thickness in Hypertensive Patients and Healthy Controls Hanan Abdullah Al-Shalan, MD; Faisal Abdulaziz AlMobarak, MD Purpose: To investigate the effect of hypertension on macular choroidal thickness, as measured by enhanced depth imaging optical coherence tomography, and to compare it to healthy normal subjects. Methods: A cross-sectional study takes place at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. A total of 10 eyes of hypertensive patients and 10 eyes of healthy controls were included. No ocular abnormalities were detected. Eyes were examined using enhanced depth imaging optical coherence tomography. Results: The mean macular choroidal thickness was (253 ± 80 µm) in hypertensive patients compared with (270 ± 87 µm) in healthy controls with borderline significant difference (p=0.045). Conclusion: Macular choroidal thickness was found to be significantly thinner in subjects with hypertension. Such a difference must be taken into consideration whenever measuring choroidal thickness 12. Immunohistochemical Characterization of Subretinal Bands in Proliferative Vitreoretinopathy Mohammed D. Al-Otaib, MBBS; Azza Maktabi, MD; Hind Al-Katan, MD; Deepak Edward, MD; Igor Kozak, MD Subretinal bands are frequently associated with proliferative vitreoretinopathy (PVR) and their removal is essential for reattachment of the retina. Thyey are maily composed of reactive avascular plaques of retinal pigment epithelial fibrous metaplasia with macrophage infiltration. 13. Chiasmal Optic Neuritis Abdulaziz Mohammad Al-Hadlaq, MD; Aliyah Hadi Al-Amery, MBBS; Alberto Galvez, MD Chiasmal optic neuritis (ON), a rare condition that affects the optic chiasm, is mostly associated with inflammatory demyelinating disorders and may be the initial manifestation of multiple sclerosis (MS). In this study we evaluated three cases of chiasmal optic neuritis. The clinical manifestations, neuroimaging results, and visual prognosis were evaluated in each patient. Routine eye examinations and auxiliary examinations including Ishihara color plate, determination of the visual field (VF) and magnetic resonance imaging (MRI) of the optic nerve and chiasm were performed. All patients presented with reduced visual acuity and visual field defects. The abnormal enhancement of the optic chiasm was clearly demonstrated on MRI in all three patients. Two of our studied patients were associated with underlying disease. The first patient was diagnosed with MS and the second patient was diagnosed with Devic syndrome. In the last patient no underlying disease was identified .The patients received systemic administration of steroids. The patient diagnosed with MS fully recovered however the other two patients only partially improved. In conclusion, although rare chiasmal optic neuritis should be considered in patients who develop bitemporal hemianopia. MRI is the modality of choice for accurate diagnosis and early diagnosis with proper treatment is essential for the restoration of visual function. Saudi Ophthalmology 2016: Program and Abstracts 67 14. Duane Retraction Syndrome Associated with a Small X Chromosome Deletion Taif A. Azad, M. Sc.; Khaled K. Abu-Amero, PhD; Altaf Kondkar, PhD; Hessa Al-Odan, MD; Arif Khan, MD; Darren T. Oystreck, MMed Sci; Ali M. Hellani, PhD &Thomas M. Bosley, MD Purpose: To describe the phenotype and genotype of a girl with bilateral syndromic Duane retraction syndrome (DRS) associated with a small deletion of the dystrophin gene. Methods: Clinical examination, neuroimaging, and retrospective chart review together with Sanger sequencing of the genes SALL4, CHN1, HOXA1, TUBB3, and KIF21A and array comparative genomic hybridization. Results: This 16 year old girl had bilateral DRS, cleft palate, and partial deafness. She and her parents had no mutations in SALL4, CHN1, HOXA1, TUBB3, or KIF21A, but the patient had a 12 kb deletion in chromosome X involving only a portion of the dystrophin gene not present in her parents. Several of the patient’s maternal family members had strabismus, but none had DRS. Conclusion: Three males with Duchenne muscular dystrophy (DMD) have been reported with unilateral or bilateral DRS, but this is the first female with a dystrophin mutation described with syndromic bilateral DRS. This patient raises the possibility that dystrophin may on occasion be a factor in the development of DRS, perhaps with both myopathic and neuropathic contributions to DRS. 15. Pattern of Neuro-ophthalmic Cases Presented to King Abdul-Aziz University Hospital’s Emergency Department in Riyadh, Saudi Arabia: A Two-year Retrospective Study Abdulrahman Abdulaziz Al-Jasser, MD; Majed Mohammad Al-Obailan, MD; Yafa Abdulrahman Al-Shamlan, MBBS; Lolwah Mohammed Alashgar, MBBS; Norah Ahmed Musallam, MBBS; Ahmed Mousa Abdul Rahim, MBBS Purpose: To assess the pattern and epidemiological characteristics of neuro-ophthalmic cases presented to ophthalmic Emergency Department (E/D) at a tertiary referral hospital, King Abdulaziz University Hospital (KAUH) in Riyadh, Saudi Arabia from May 2013 to April 2015. Method: A retrospective study that implied all patients who presented to the ophthalmology E/D from may 2013 to April 2015 at KAUH. Data were collected from ophthalmic emergency registry book for all patients fulfilling the inclusion criteria and were analyzed according to demographics, date of visit, diagnosis and management. Results: Among the emergency cases that presented to KAUH for two consecutive years, 414 cases were diagnosed as neuro-ophthalmic patients. Mean (SD) age was 38.1(19.0) (ranging from 2 months-88 years). Of them, 93.5% were above 15 years of age, gender was almost equally distributed, with the majority being Saudi citizens. Most of cases (78.3%) had unilateral ocular involvement, while (21.7%) were bilateral. Optic neuritis was the most prevalent diagnosis comprising (22.5%) of neuro-ophthalmic emergencies, leaving (15%) for 6th nerve palsy, (10.9%) 3rd nerve palsy, (8.7%) bilateral optic disc swelling, and (7%) 7th nerve palsy in addition to other causes. Conclusion: Above all Neuro-ophthalmic emergencies, optic neuritis was the most prevalent diagnosis followed by 6th cranial nerve palsy then 3rd cranial nerve palsy. Early detection and referral of Neuro-ophthalmic cases would enable delivering the optimal healthcare to such cases. 16. Anophthalmic Chronic Inflammation due to RTV Orbital Implant Silvana Schellini, MD; Alicia Galindo-Ferreiro, MD; Laila Al-Ghafri, MD; Sahar ElKhamary, MD; Azza Maktabi, MD Objective: To advise physicians about the possibility of chronic socket inflammation secondary to intraorbital implants used to enhance anophthalmic socket volume or orbital fracture repair. Cases report: Two anophthalmic cases who had enucleation and multiple orbital surgeries to improve the sunken sockets developed pain, intense discharge and contracted cavities with chronic inflammation in the socket no responsive to clinical treatment. CT scan showed in each patient a hypodense foreign body involved by intense inflammatory reaction. Both patients had the implants removed by excisional surgery and a RTV (Room themperature vulcanize) silicone implant was recognized. After the implant removal patients had no more socket inflammation. 68 Saudi Ophthalmology 2016: Program and Abstracts Conclusions: Chronic inflammation in the sockets from patient who had previous surgeries and received implants should be suspected of intraorbital inflammatory reaction against the applied implant. We confirmed our diagnosis using image exams and the definitive treatment was the implant removal. 17. Outcomes of Two Surgical Techniques for Major Trichiasis Silvana Artioli Schellini, MD; Lucieni Barbarini Ferraz, MD; Roberta Lilian Fernandes de Sousa Meneguim, MD; Alicia Galindo-Ferreiro, MD; Ana Cláudia Viana Wanzeler, MD; Michelli Massae Saruwatari; Larissa Horikawa Satto; Carlos Roberto Padovani Purpose: To analyze the patient outcomes of two surgical techniques for major trichiasis. Method: A retrospective chart review was performed of 67 patients (89 eyelids) with major trichiasis who underwent surgical treatment using one of two techniques: Van Millingen (intermarginal split with graft; ISG group) technique or lid anterior lamella resection (ALR group). There were 30 eyelids in the ISG group with mean patient age of 71.8 years and 63.3% were females. There were 59 eyelids in the ALR group with mean patient age of 72.5 years and 52.5% were female. The minimum postoperative follow up was 6 months. Statistical analysis included descriptive measures, Goodman association test for contrasts between and within multinomial populations and non-parametric Mann Whitney test for comparison between groups. P<0.05 was considered statistically significant. Results: The underlying causes of trichiasis were, blepharitis (37.07%), chronic meibomitis (21.3%), multiple causes (20.2%), ectropion (11.2%), actinic keratosis (6.7%) or prior ocular surgery (3.3%). Postoperatively, in the ISG group, there were 20% eyelids with complete success, 50% underwent laser or electrolysis, 16.7% required further surgery and 13.3% were unsuccessful. Postoperatively, in the ALR group there were 47.5% eyelids with complete success, 46.7% underwent laser or electrolysis, 6.8% required further surgery and 5.1% were unsuccessful. There was a higher statistical chance of complete success with ALR (P<0.05). Conclusions: ALR is superior than ISG surgery for major trichiasis. There is a greater chance of success with ALR and it is technically simpler. 18. Analysis of Toll-like Receptor rs4986790 Polymorphism in Saudi Patients with POAG Mohammad Taif Anwar Azad, MD; Saleh A. Al-Obeidan, MD; Altaf A. Kondkar, MD; Ahmed Mousa, MD; Tahira Sultan, MD; Essam A. Osman, MD; Khaled K. Abu-Amero, PhD Purpose: To investigate whether SNP rs4986790 in Toll-like receptor 4 (TLR) is a risk factor for primary open angle glaucoma (POAG) in Saudi population. Method: A cohort of 85 unrelated POAG patients and 95 unrelated control subjects from Saudi Arabia were genotyped utilizing Taq-Man(r) assay. The association between mutant genotypes and various clinical indices important for POAG was investigated. Results: Among cases, the normal pattern (A/A) was detected in 70 (82.4%) of subjects, A/G in 14 (16.5%) and G/G in one subject only (1.2%). Among controls, prevalence of the genotype (A/A) was detected in 86 (90.5%), the (A/G) genotype in 8 (8.4%) and homozygous mutated genotype (G/G) in 1 (1.1%) subjects. Comparing cases to controls, the odds ratio of having heterozygous mutation (A/G) was 2.15 [95% CI: 0.853 - 5.417], which was not significant (p= 0.114). The odds ratio of having homozygous mutation (G/G) was 1.22 [95% CI: 0.075 19.99], which was statistically significant (p= 0.568). Likewise, the presence of the mutated allele (G) was insignificantly different between cases and controls (p= 0.154). Comparing cases to controls as regards comorbidity with other systemic diseases, there were no statistically significant difference between groups in all assessed diseases except for a family history of glaucoma (p = 0.014) Conclusion: In conclusion, we could not detect any direct link between genotypes or allele frequencies of SNP rs4986790 in the TLR4 gene and POAG. In contrast, genotype (A/A) may be protective against POAG especially among individuals with no family history of glaucoma. Saudi Ophthalmology 2016: Program and Abstracts 69 19. Congenital Hemifacial Hypertrophy and Glaucoma Reham Dakam Al-Qahtani, MBBS; Halla Al Abdul-Hadi, MBBS; Ahmed Al-Habash, MD; Sami Al-Shahwan, MD Congenital Hemifacial hypertrophy (CHH) is a congenital malformation of unknown etiology characterized by overgrowth of soft and hard tissues of one side of the head and face that may lead to ocular manifestations ptosis, ectropion uvea, and glaucoma. Ipsilateral hemifacial hypertrophy often associated Prader Willi syndrome, and neurofibromatosis. The diagnose of the disease is challenging since it is even rare than the true form to be encountered in clinical practice. We report a case of a 30 years old female with congenital ectropion uveae, glaucoma, ptosis,ipsilateral hemifacial hypertrophy and proptosis that ended with No Light Perception vision(NLP) and optic atrophy. 20. Paintball Ocular Injury Mohammad Al-Amry, MD; Nora Abdulmohsen Al-Yousif, MBBS; Halla Al-Abdulhadi; MBBS; Huda A Al-Ghadeer, MD Purpose: To present 3 cases of severe ocular injuries after trauma by paintball gun pellets Method: Case report Results: We had 3 cases presented to the emergency room at King Khaled Eye Specialist Hospital (KKESH) on separate occasion after they sustained trauma by paintball gun pellets while involved in recreation games.one case developed vitreous hemorrhage, commotion retinae with choroidal detachment, later he developed retinal tear managed by laser retinopexy, he ended by vision of best correction 20/160 while 2 cases had severe hyphema and developed cataract later on managed by cataract surgeries and lens implantation whom they regained vision in the range of 20/30. Conclusion: The paintball game is new to our community and needs safety roles, it resulted in severe ocular injuries , it needs more highlighting of safety and awareness. 21. Compliance of Glaucoma Patients to Ocular Hypertensive Medications among the Saudi Population Priscilla Wairimu Gikandi Purpose: To evaluate the compliance of glaucoma patients to medical treatment and its impact on the intraocular pressure (IOP) and to verify the associated risk factors for noncompliance. Methods: All recruited patients were examined at the ophthalmology clinics of King Abdulaziz University Hospital, Riyadh, Saudi Arabia between May and August 2012. Patients were interviewed and subjected to answer a questionnaire that was developed based on a pilot test. Collected data included age, gender, number of prescribed drugs, and different reasons for noncompliance to the prescribed drugs. Results: Noncompliance was detected in 18 (19.4%) of the recruited patients. Factors associated with noncompliance demonstrated a trend toward older patients, males, patients with lower IOP at presentation, higher cup to disc ratio, and drug self-administering patients. However, the only statistically significant characteristic was being under lifelong medications (P = 0.005). Conclusion: Noncompliance was detected in around one-fifth of our glaucoma patients, particularly, the older group. Awareness programs, maintaining good patient-physician relationship, and personalizing treatment can lead to better adherence to treatment. 22. Severe Bilateral Episcleritis after Incidental Trauma by Eye Lashes Serum Mohammad Al-Amry, MD; Halla Ahmed Al-Abdulhadi, MD; Nora Abdulmohsen Al-Yousif; Saleh AlOthaimeen, MD Purpose: To present a case of severe bilateral episcleritis after use of eyelashes serum 70 Saudi Ophthalmology 2016: Program and Abstracts Method: Case report Results: A 50-year old lady presented to the emergency room complaining of severe redness and ocular pain in both eyes after she used an eye lashes serum for cosmesis incidentally the chemical substance spilled into the eyes on examination she had bilateral severe episcleritis with clear cornea and quiet anterior chamber did not have visual disturbances BCVA:20/20 both eyes she was managed with application of topical steroid in the form of fluorometholone drops 4 times daily for 2 weeks she recovered completely in 1 week with no sequelae Conclusion: Cosmetic products can spill into the eyes and cause severe ocular surface inflammation like episcleritis. Saudi Ophthalmology 2016: Program and Abstracts 71 Video Abstracts 1. Double Layer AMT for Conjunctival Reconstruction after Recurrent Squamous Cell Carcinoma Hernan M Osorio, MD Purpose: A 69-yr-old male diagnosed of temporal recurrent pterygium OD attended consultation for second opinion. Method: The patient clinical appearance was very concerning for OSSN. OSSN excision was done and conjunctival reconstruction with double layer AMT was obtained. Histopathologic analysis demonstrated squamous cell carcinoma without horizontal or margins extension. Topical chemotherapy with topical interferon alpha 2B (1 million units/mL) four times per day was administrated for 3 months. Results: Double layer AMT and Interferon alpha 2B allowed complete remission of squamous cell carcinoma without recurrence after 5 years. However by conjunctival impression cytology, goblet cells were absent over AMT. Conclusion: Double layer AMT and Interferon alpha 2B is useful to treat squamous cell carcinoma. Amniotic membrane is fully integrated with the surrounding conjunctiva but not replace the normal epithelium. 2. Surgical Treatment of Conjunctival MALT Lymphoma Hernan M Osorio, MD Purpose: A 45-yr-old female was referred for confirmed conjunctival reactive lymphoid hyperplasia OS. Method: Conjunctival biopsy was compatible with Conjunctival MALT Lymphoma OS. Systemic work up discarded systemic extension and bacterial origin (Chlamydia sp or H. pylori). Patient refused local radiotherapy. 360º Conjunctival MALT Lymphoma excision was done and 3 cycles of rituximab chemotherapy was completed. Results: After 5 years of follow-up patient has complete clinical remission. Conclusion: Conjunctival MALT lymphoma can be successful treated with local excision and systemic chemotherapy with rituximab. Local side effects of radiotherapy, as cataract and dry eye, can be avoided with surgical excision and systemic chemotherapy. 3. Corneal Subepithelial Hemorrhage: Diagnosis and Management Salman Abumazyad, MD A 72-year-old man complained of sudden loss of vision on his left eye upon waking up this morning. He gave a history of uncomplicated cataract surgery of the same eye few years back. no history of contact lens wearing. Ocular examination showed hemorrhagic corneal epithelium cyst that has no communication with anterior chamber, Peripheral corneal vessels were seen at different portions of the cornea and the epithelial surface did not reveal any fluorescein staining. Epithelial cyst was drained using fine needle puncture through the most inferior part of the cyst resulted in complete passive blood drainage with excellent corneal clarity. 4. The Management of Black Cataract with Pseudoexfoliation (Pxf) and Phacodonesis in Small Pupil Saeed Al-Gehedan, MD Pseudoexfoliation, due to zonular instability with Phacodonesis and poor pupillary dilation, have been identified during pre-op exam as high risk factors for surgical complications that require careful preoperative planning and intraoperative care to ensure successful and safe surgery. The use of specialized adjunctive devices such as highly cohesive viscoelastics, iris retractors and capsular tension devices has increased the margin of safety in these potentially complex cataract surgeries. 72 Saudi Ophthalmology 2016: Program and Abstracts 5. Challenging Cataract Surgery in Case of Corneal Cystinosis Saeed Al-Gehedan, MD Cystinosis is a rare AR disorder characterized by widespread tissue deposition of non-protein cystine crystals as a result of a defect in lysosomal transport. The deposition of cystine crystals in the cornea causes visual disability and opacity which makes cataract surgery a challenge. Phacoemulsification and posterior chamber intraocular lens implantation was performed under topical anesthesia. A procedure that was complication free and the patient had excellent UCVA. 6. Cataract Management in Marfan’s Syndrome: Techniques and Outcomes Saeed Al-Gehedan, MD Cataract surgery in Marfan’s syndrome is a challenge with hallmark issues such as lens subluxation and progressive zonular dehiscence. Phacoemulsification and Artizan lens implantation was done for a 40-year-old man, under topical anesthesia for both eyes one week apart. No complications were encountered intraoperatively for any of the eyes. one month Post-Op, the patient had (20/20) UCVA in both eyes 7. Management of Subluxated Lens Saad Saleh Al-Harbi, MD Purpose: To present surgical management of three cases in which the lens is subluxated. Method: Surgical managements with different approaches will be presented to overcome difficulties that ophthalmologist faced with subluxated lens after trauma or in association with Marfan or Weil-Marchesani syndrome. Results: All cases result in excellent visual outcome without complications. Conclusion: The surgical management of ectopia lentis has numerous challenges and options. The Key of success in management of these cases is to have proper clinical evaluation and plan the right surgical approach to ensure the best possible outcome. 8. Lessons from White Cataract Abdulelah Abdulaziz Al-Abdullah Purpose: To discuss the diagnosis and management of couple of interesting and challenging cases with white cataract presented to a vitreoretinal surgeon. Method: five cases with their surgical video will be discussed in term of diagnosis and management Results: The first was for young lady with spontaneous posterior capsule rapture and drop lens material. Eventually she was found to have stickler syndrome managed with PPV, PPL. Second case was for elderly man presented with nuclear sclerosis cataract with DME. He was scheduled for surgery in 2 months. His nuclear sclerosis changed to white cataract? No history of trauma But he had history of high IOP after leaving the clinic2 months earlier. Can high IOP cause posterior capsule rapture? Case three: white cataract due to lens touch post vitrectomy with drop lens material in the vitreous recognized accidently since her posterior capsule was intact!! Can posterior capsule heal itself? Case 4: white cataract post SO Removal with posterior capsular fibrosis. During surgery anterior capsule was extended due to high intra-capsular pressure in both directions. In addition an intentional posterior capsulrhexis was made. IOL was placed in the sulcus. Case 5 white cataract deflated from the anterior Saudi Ophthalmology 2016: Program and Abstracts 73 capsule but it was deflated from posterior capsule as well. It is most likely secondary to unrecognized lens touch in a previous vitrectomy. Conclusion: in this presentation lessons from white cataract will be extended in term of causes and management. 9. New Technique to Overcome Difficult Posterior Vitreous Detachment Mohammed Salem Asiri, MD Purpose: to illustrates a new technique for induction of Posterior vitreous detachment (PVD) in difficult cases. Method: this video will contrast the traditional way of inducing a PVD by applying suction over the disc which can be difficult or impossible in certain cases to a new technique which is safe and effective. A 53-year-old male underwent triamcinolone assisted-pars plana vitrectomy with difficult PVD induction using the traditional way, this difficulty was overcome using this technique. Results: successful induction of the posterior vitreous detachment was demonstrated in this case using 23 guage Tano Diamond Dusted Membrane Scraper and 23-gauge membrane pick. Gentle pressure applied over posterior hayloid nasal to the disc to release the vitreous from the retina at a small spot. A membrane pick then was used to hook the vitreous and pull it up leading to complete PVD. Conclusion: This video will highlight a new technique to overcome difficult situation in inducing PVD. 10. Spontaneous Internal Limiting Membrane Detachment Mistaken as a Retinal Detachment Mohammed Salem Asiri, MD Purpose: To report a case of spontaneous internal limiting membrane detachment following traumatic endophthalmitis in a child. Method: A 3-year-old boy presented with history of needle injury to his right eye underwent uneventful core vitrectomy for traumatic endophthalmitis with intravitreal antibiotics injections, two weeks after, in the postoperative visit a hazy view to the retina raised the suspicion of retinal detachment, B-scan showed retinal detachment involving the macula. Results: Pars plana vitrectomy was done based on the result of the B scan for repair the presumed retinal detachment. Intraoperatively, we noticed that the internal limiting membrane (ILM) was detached with flat retina. Confirmatory staining with brilliant blue demonstrated the extent of ILM detachment. Conclusion: This video demonestrated a unique and rare observation of spontaneous ILM detachment which could mimic retinal detachment on ultrasonographic examination. 11. Surgical Procedure of Implanting Argus II Retinal Prosthesis System Eman Saeed Al-Kahtani, MD The Argus II Retinal Prosthesis System is FDA approved as a humanitarian use device and the first implanted device to treat adults with severe retinitis pigmentosa. The System is designed to improve the visual function of patients and may produce the sensation of light? it has three parts: a small electronic device implanted in and around the eye, a tiny video camera attached to a pair of glasses, and a video processing unit that is worn or carried by the patient. Selecting patient properly and proper handling of the implant during the implantation procedure with extreme care especially the electrode cable and array, are the key of success. The video describing the surgical procedure and implantation of the Argus II Implant, which shows crucial steps of handling the implant and taking the array it onto the retina. 74 Saudi Ophthalmology 2016: Program and Abstracts 12. Rhegamtogenous Retinal Detachment in Immunocompromised Patient with PORN Secondary to CMV Infection Eman Saeed Al-Kahtani, MD I am presenting a video of the surgical procedure with pre and post photo, and OCT for a 58 years old male with history of Liver transplant 7 yrs earlier due to chronic viral hepatitis B presenting with a one month history of decreased vision and floaters in his right eye increasing over the past week secondary to foveal sparing rhegmatogenous retinal detachment with large break superior nasal to the disc developed in the area of large retinal infiltrate and necrosis. Also multiple smaller vitreoretinal infiltrates and arterial sheathing were noticed mainly posterior to the equator. OCT showed marked intraretinal fluid and epiretinal membrane with foveal sparing subtotal retinal detachment. Clinical picture of progressive outer retinal necrosis (PORN), and secondary RRD, with positive PCR sample for Cytomegalovirus (CMV) infection in immuno-compromised post liver transplantation was the final diagnosis. Pars Plana Vitrectomy , given extra precaution during vitrectomy to avoid the multiplicity of atrophic posterior breaks in thin necrotic retina, endolaser, intravitral Ganciclovir 2mg/0.1 mL and Silicon Oil 5000 Centistockes injections were done. PCR testing of his vitreous was positive for CMV. He was then seen by his hepatologiest who started him on systemic antiviral agents Valcyte valgancicovit 450 mg tab. The outcomes of this entity may be devastating and include blindness from complicated retinal detachment and optic atrophy. While early diagnosis, potent specific and supportive drug therapy and surgical treatment remains the key to successful management. The prognosis of untreated such a case has traditionally been poor, however good visual outcome of 20/70 as a result of aggressive surgical and supportive drug intervention in an efficient and timely manner in our case. 13. Funnel Shape Retinal Detachment: It Is Not Operable!! “My Fellow Said” Abdulelah Abdulaziz Al-Abdullah, MD Purpose: To illustrates the challenges and difficulties in managing chronic traumatic retinal detachment. Method: 20-year-old male with history of road traffic accident resulted in ruptured globe with corneal scleral wound repaired on another facility and referred with hyphema and retinal detachment. Results: 7 weeks post his primary repair the patient underwent retinal detachment surgery for total funnel shape RD base on the B scan. There was no view to the fundus due to hyphema. My fellow started the surgery by cleaning the anterior chamber then he looked at the retina which was in a funnel shape with retinal tissue adherent to the iris detachment and its complexity to declare that it’s not operable. With the help of perfluorocarbon heavy liquid and 360 relaxing retinoectomy we managed to flatten the retina under silicone oil. Conclusion: This video will highlight some techniques to overcome complex retinal detachment. 14. Replacement of Phakic IOL : Techniques and Outcomes Saeed Al-Gehedan, MD This is a 28 year old male patient who underwent Cachet phakic AC IOL implantation four years back somewhere else. The patient was not happy by the cosmetic appearance of his eye and was complaining of glare & halos with VA 20/20 in this eye. Patient was offered an exchange of the AC IOL by a PC phakic IOL , namely the STAAR Visian ICL. A procedure that was complication free and 20/20 UCVA with a great patient Satisfaction. Saudi Ophthalmology 2016: Program and Abstracts 75 Participating Organizations Special thanks to all sponsors for participating in the Saudi Ophthalmology 2016 76 Booth No. Name of the Sponsors/Exhibitors Diamond Sponsors D1 D2 D3 D4 D5 Koln Health Care Medicals International Bayer AMICO Magrabi Eye Hospitals & Centers Platinum Sponsors P2 P3 P4 P5 P6 P7 P8 Experts Medical Supplies Est. Jamjoom Pharma Abdulrehman Al Gosaibi G.T.C The Eye Consultants Bauch & Lomb Gulf Medical Company First Gulf Medical Company (Medical) Gold Sponsors G1 G3 G4 G5 Saudi Services & Health CARE Basha Medical Group Zarka Al Yamama Lens Factory Al Basar Medical Supplies Silver Sponsors S1 S2 S3 & 111 S4 Media Center Saudi Ophthalmological Society (SOS) Al-Riyadh Medical Services Red Sea Ophthalmology Symposium (RSOS2017) Exhibitors 101 103 105 106 108 109 110 Riyadh Ophthalmology Residency Community AP King Saud University Al Jamil Optical Health Mirrors Est. for Trade Saudi Medical Journal MEACO Al Basar International Foundation Saudi Ophthalmology 2016: Program and Abstracts
