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189 American Academy of Ophthalmology Academy staff are available at the Academy Resource Center (North, Booth 3569) to answer any Academy-related questions you may have. © 2009 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology P.O. Box 7424, San Francisco, CA 94120-7424 Tel: 415-561-8500 Fax: 415-561-8533 PAAO Original Papers Sunday – Tuesday, Oct. 25 – 27 9:00 AM – 5:30 PM A panel discussion will follow each paper presentation. Selection Committee The Pan-American Association of Ophthalmology Scientific Program Committee selected all Original Papers. See page 33 for committee details.

2009 Final Program PAAO Papers

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Page 1: 2009 Final Program PAAO Papers

189

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Academy staff are available at the Academy Resource Center (North, Booth 3569) to answer any Academy-related questions you may have.

© 2009 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology

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PAAO Original PapersSunday – Tuesday, Oct. 25 – 27

9:00 AM – 5:30 PM

A panel discussion will follow each paper presentation.

Selection Committee The Pan-American Association of Ophthalmology Scientific Program Committee selected all Original Papers.

See page 33 for committee details.

FinalProgram.book Page 189 Monday, September 21, 2009 5:53 PM

Page 2: 2009 Final Program PAAO Papers

* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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Cataract

Sunday, Oct. 2511:30 AM - 12:30 PM

SOUTH, Room 236

PA104 11:30 AMBi-axial Prechopping With Two 25-Gauge CannulasPresenting Author: Arturo Perez Arteaga MD

Purpose: To compare the new method of biaxial prechop with two 25G cannulas(BAPC25G) with traditional forceps prechop. Methods: 100 eyes were operated byone surgeon utilizing the BAPC25G technique and the results were compared with aprevious group (retrospective revision) of 100 eyes operated by the same surgeonwith forceps-prechop technique. Results: No differences between gropus in cor-neal edema, visual outcome, surgical time and phaco power and time. Significativedifference was found in posterior capsule rupture (1/100 vs 4/100). Conclusion:BAPC25G is a safe and effective technique. It can decrease the risk of damage tothe capsular bag during prechop maneuvers.

11:37 AMPanel discussion of previous paper

PA105 11:40 AM700 Micron Technology for Lens Extraction Without Ultrasonic PowerPresenting Author: Arturo Perez Arteaga MD

Purpose: To demonstrate the safety and efficacy of 700 micron technology for lensextraction (micro-biaxial) with no ultrasonic power for soft nucleus. Methods: 50eyes were operated with microbiaxial technique utilizing the phaco hand-piece andcompared with the results of 50 eyes with soft nucleus, operated by the same sur-geon with microbiaxial technique without phaco handpiece (utilizing only irrigation/aspiration). Results: No differences were found in visual outcome, inflammatoryprocess and perioperative complications. Significative differences were found inphaco time, total surgical time and speed of visual recovery. Conclusion: Micro-biaxial technique with no-ultrasonic power is a safe ans effective technique for lensextraction in soft nucleus cases and can improve the time of visual recovery.

11:47 AMPanel discussion of previous paper

PA106 11:50 AMReduction in Preexisting Astigmatism by Limbal Relaxing Incisions in Patients Undergoing PhacoemulsificationPresenting Author: Rakesh Kumar Bansal FRCS(ED)

Co-Author(s): Anamika Garg MBBS**, Sunandan Sood MS**, Arun K Jain MDPurpose: To study the role of limbal relaxing incisions (LRI) in reducing preexistingastigmatism in patients undergoing phacoemulsification. Methods: Selectedpatients were subjected to LRI if the preexisting astigmatism was ≥ 1 D. AMO onlinecalculator was used to determine the extent of LRI with depth kept fixed at 0.6 mm.Results: In 25 eyes average preexisting astigmatism was 1.85 ± 1.41 D. Averagepostoperative astigmatism after a minimum follow-up of 1 month was 0.93 ± 0.37D, with average reduction in cylindrical power of 0.92 D, which was found to be sta-tistically significant (P < .5). Two eyes developed micro leak during the procedure.Conclusion: LRI is safe and effective in reducing moderate amount of astigmatismin patients undergoing phacoemulsification.

11:57 AMPanel discussion of previous paper

PA107 12:00 PMPrevalence of Blindness and Cataract Surgery in Lumbini Zone, NepalPresenting Author: Anil Sherchan SR DO

Co-Author(s): Pradeep Bastola SR MD, Manoj Kumar Sharma**, Ram Prasasd Kandel JR MPH**, Kent L Bassett MD**Purpose: To estimate the impact of the Lumbini Eye Institute in the prevalence ofblindness in Lumbini Zone Nepal. Methods: People aged 50 years and over wereenrolled in the study using stratified cluster randomization designed in Lumbini Zone.Subjects in the 32 selected clusters were recruited through door-to-door visits. Eachrecruited subject was examined by an ophthalmologist. Results: Out of 5916selected subjects, 86.9% were examined, mean age being 60 years. The percent-age of those presenting with total blindness was 4.6%, of which 5% were male and4.3% were female. Cataract was the principal cause for bilateral blindness (48%).Conclusion: The finding suggests the need to focus on cataracts more.

12:07 PMPanel discussion of previous paper

PA108 12:10 PMRefractive and Aberrometric Results of Aspheric IOL: a Multicentric StudyPresenting Author: Fabrizio I Camesasca MD

Co-Author(s): Paolo Vinciguerra MD*, Damien Gatinel MD*, Burkhard Dick MD**Purpose: A prospective, multicentric study on the aspheric Zeiss Invent ZO IOL,providing the same spherical aberration as the natural lens. Methods: Sixty eyesenrolled through 3 different European centers received complete ophthalmologicalevaluation and Nidek OPD aberrometry preoperatively and at 1- and 6-month inter-vals. Modulation transfer function (MTF) and aberrometric results were comparedwith a sample of 97 healthy, phakic eyes. Results: No significant loss of BSCVAwas noticed. At the 6-month interval, high-order aberration MTF and spherical aber-ration were similar in both the operative and control groups. Conclusion: Invent ZOmaintains aberrations at the level of healthy, unoperated eyes.

12:17 PMPanel discussion of previous paper

PA109 12:20 PMPosterior Capsule Rupture During Phacoemulsification: Comparison With Uncomplicated Cases on Long-Term Follow-UpPresenting Author: Daniel A Badoza MD

Purpose: To compare phacoemulsification with intraoperative rupture of the poste-rior capsule (RPC) with uncomplicated cases. Methods: We retrospectivelycompared visual acuity (VA) and refraction in 13 cases with RPC to 126 controls.Minimum follow-up was 24 months. Results: Preoperatively, mean VA was 0.38 inthe RPC group and 0.40 in the control group (P = .72), changing to 0.875 for RPCand 0.95 for controls (P = .14) after surgery. Mean preoperative refraction was -0.03 D for the RPC group vs. -1.49 D for controls (P = .18); postoperative refrac-tion was -0.875 D in the RPC group vs. -0.13 D in controls (P = .009). No retinaldetachment occurred after RPC. Conclusion: Phacoemulsification with rupture ofthe posterior capsule with no significant vitreous in anterior chamber achieved visualresults similar to those of uncomplicated cases.

12:27 PMPanel discussion of previous paper

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PAAO Original Papers

* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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Monday, Oct. 2610:15 - 11:15 AMSOUTH, Room 238

PA138 10:15 AMAphakia Correction With the Retroiridally-Fixated Artisan IOLPresenting Author: Vitor R Fernandes MD

Co-Author(s): Tiago P T Monteiro MD, Ricardo A Pereira MD**, Manuel Fer-nando Lopes Domingues MD**, Fernando M Falcao-Reis MD PHD**Purpose: To evaluate the efficacy, safety, and stability of secondary implantation ofretroiridally fixated Artisan IOL to correct aphakia. Methods: Ten aphakic eyes/10patients (median age: 69.4 years) underwent secondary retroiridial fixation of ArtisanIOL. Results: All surgeries were performed without complications. Mean postopera-tive refraction was -0.75 D (range: -1.75 to + 1.0 D). Preoperative BSCVA variedfrom hand motions to 0.3 Snellen. Median postoperative BSCVA was 0.4 (range:0.1–0.9). There were no cases of IOL dislocation. Conclusion: In selected cases,the implantation of a retroiridally fixated Artisan IOL is an effective, safe, and stablemethod to correct aphakia.

10:22 AMPanel discussion of previous paper

PA139 10:25 AMCongenital Cataract Surgery in Relative Anterior Microphthalmos: A Case ReportPresenting Author: Arturo J Ramirez-Miranda MD

Co-Author(s): Ingrid Urrutia-Breton MD**, Eduardo Ayup-Arguijo MD**, Eduardo Chavez-Mondragon MDRelative anterior microphthalmos (RAM), the condition of eyes with normal axiallength but a small anterior segment, is responsible for a high incidence of complica-tions after cataract surgery. A 49-year-old man complaining of decreased photopicvisual acuity. On evaluation, best corrected visual acuity was 20/30 in both eyes,small and steep corneas, shallow chamber and fetal nucleus congenital cataract; heunderwent anterior segment analisys by Pentacam`s Scheimpflug images and axiallenght measured by IOL master which confirmed the diagnosis. Phacoemulsificationwas performed with acrilyc lens implantation in both eyes. There are just a fewreports of RAM with congenital cataratc, confirmed diagnosis by Pentacam andadjusted IOL power predicted by Hoffer Q formula in the IOL master allowing visualimprovement

10:32 AMPanel discussion of previous paper

PA140 10:35 AMMicroincision Cataract Surgery (2 mm) With the Acri.Comfort 646 Toric IOL for the Management of AstigmatismPresenting Author: Bassam Elkady MD**

Co-Author(s): Cláudia D Costa-Ferreira MD, Jorge L Alio MD PhD*, Vanessa Pongo MD**Purpose: Evaluate toric IOL (Acri comfort 646 TLC) for the correction of cornealastigmatism. Methods: Astigmatism was studied using 3 vectors: target inducedastigmatism (TIA), surgically induced astigmatism (SIA), and difference vector (DV),described by the Alpins method of 21 eyes with corneal astigmatism. Results:Mean pre- and post-operative cylinder was -4.46 1 2.23 D and -0.45 10.63,respectively. Arithmetic mean difference vector was 0.47 1 0.61. 91% of astigma-tism was corrected. Mean toric EOL axis rotation was -1.75 1 2.93. Conclusion:Acri.comfort 646 TLC is precise, safe and effective to correct moderate and highastigmatic defect.

10:42 AMPanel discussion of previous paper

PA141 10:45 AMRole of Gender in Patient Satisfaction After Cataract Extraction and Multifocal Intraocular Lens (MIOL) ImplantationPresenting Author: Helga P Sandoval MD*

Co-Author(s): John W French MD, Mohamed A Guenena MD*, Kerry D Solo-mon MD*Purpose: To evaluate the role of gender in patient satisfaction after multifocal IOL(MIOL) implantation. Methods: 112 patients following bilateral MIOL implantationwere divided by gender: females, n =76 and males, n = 36. Overall (OS), distance(DS), intermediate (IS), near (NS), and night vision satisfaction (NS) were assessedusing a scale from 0 (very dissatisfied) to 10 (highly satisfied). Results: No signifi-cant differences in age, residual refractive error, postoperative visual acuity(uncorrected or best corrected) at distance, intermediate, and near were foundbetween groups. OS was significantly higher in females than males (8.9 vs. 8.4, P =.040), as well as intermediate (8.3 vs. 7.4, P = .021). Conclusion: Multifocal IOLimplantation provides high patient satisfaction, with females being more satisfied thanmales.

10:52 AMPanel discussion of previous paper

PA142 10:55 AMAnalysis of Re-used Blades Used in Phacoemulsification by Scanning Electron MicroscopyPresenting Author: Priscila da Rosa Camaratta

Co-Author(s): Luciano Albuquerque MD**, Claudia Faganello ScD**, Mauricio Grillo**, Luciana Freitas**, Fabiana Quartiero**, Ana Veiga**, Joao A Pigatto PhD**To evaluate by scanning electron microscopy the sharpness of the edge of brandnew surgical blades and consecutively used surgical blades in phacoemulsification.Twenty-five angled ophthalmic knife were evaluated after corneal incision in rabbits.The subjects were divided in five groups: G 1 (control), G 2, blades used once; G 3,blades used twice; G 4, blades used four times; G 5, blades used six times. Bladebody irregularities and organic material were observed on all used surgical blades (G2, 3, 4 and 5), but not on new surgical blades (G 1). In addition, G 5 revealed moreirregularities. Reusing blades for phacoemulsification may produce structuralchanges and its clinical implications need to be evaluated due to the possible relationwith postoperative complications.

11:02 AMPanel discussion of previous paper

PA143 11:05 AMSurgical Technique for Implantation of the Synchrony Dual Optic IOL, Five Years EvolutionPresenting Author: Ricardo Alarcon MD*

Co-Author(s): Victor Manuel Bohorquez MD**, Luis G Vargas MD**Purpose: The key surgical steps required for successful implantation of the Syn-chrony dual optic IOL. Methods: The five year evolution of the surgical techniquefor implantation of the Synchrony IOL will be presented.Insights gained during thedevelopmental process of this unique lens will be discussed. Results: A summaryof the techniques used during surgery will be given. Videos showing the delivery ofthe lens into the capsular bag using a newly developed preloaded injector. Conclu-sions: A focused, methodical surgical technique assures optimal results and a highlysatisfied patient.

11:12 AMPanel discussion of previous paper

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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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Tuesday, Oct. 279:00 - 10:00 AM

SOUTH, Room 238

PA156 9:00 AMFunctional Vision in Presbyopia-Correcting IOLs: A Randomized Comparison Between Accomodating Dual Optic and Diffractive Multifocal IOLsPresenting Author: Ricardo Alarcon MD*

Co-Author(s): Victor Manuel Bohorquez MD**, Luis G Vargas MD**Purpose: To compare visual performance between a diffractive multifocal IOL and adual optic accommodating lens Methods: Prospective double-masked randomizedstudy. Fifty patients were implanted with each IOL binocularly. After 1 year, Visualacuity and reading speed measured with full distance correction were evaluated at40, 60, 80, 100, 200 and 400 cm. Results: Visual acuities and reading speed(with distance correction) were similar at distance and near (P>0.05 ANOVA). At allintermediate distances Synchrony was significantly better than ReSTOR (P<0.05, t-test). Conclusion: Synchrony IOL provides a better range of functional vision, withsimilar performance at near

9:07 AMPanel discussion of previous paper

PA157 9:10 AMThree-Year Results With Synchrony Dual-Optic Accommodating IOLPresenting Author: Victor Manuel Bohorquez MD*

Co-Author(s): Ricardo Alarcon MD**, Luis G Vargas MD**Purpose: Evaluation of 3 year visual outcomes of the Synchrony IOL. Methods:14 patients implanted with the Synchrony IOL were evaluated at 12, 24 and 36months. Uncorrected and distance corrected visual acuity for far, intermediate andnear were assessed. Results: After 3 years, the mean uncorrected visual acuity(logMAR) remains stable: -0.125 distance, 0.165 intermediate and -0.030 near.DCNVA remains stable over time. After 36 months, over 100% of patients can read20/40 or better. Conclusion: Synchrony showed comparable visual outcomes atall visits. Visual stability is maintained with this dual-optic accommodating IOL 3 yearsafter implantation

9:17 AMPanel discussion of previous paper

PA158 9:20 AMHow to Teach Phacoemulsification in a Secure WayPresenting Author: Felipe Torres MD

Co-Author(s): Monica C Mendoza MD**, Silvio Arellano MD**, Julio Blanco MD**, Johnny Zumaeta MD**, Ivan Cornejo MD**Purpose: To describe a way to teach phacoemulsification. Methods: Our hospitalis the main teaching center in Peru. We had 2 PGY-3 residents who participated in1710 cataract surgeries. Using a protocol and an objective evaluation form to assessresidents’ skills in cataract surgery, we measured the surgical difficulty of each casefor residents. Tutors were aware of any surgical complications and solved them.Results: Of the 1710 surgeries, PGY-3 residents participated in 799 surgeries(511 ECCE and 288 phaco). We measured the security of the tutorials through thecomplication rate (posterior capsule rupture and vitreous loss), which in this group ofresidents was 6.9% during phacoemulsification. Conclusion: Teaching ophthal-mology residents phacoemulsification must be done in a secure way in order to get alearning curve with few complications.

9:27 AMPanel discussion of previous paper

PA159 9:30 AMLong-term Performance of Dual-Optic Accommodating IOLsPresenting Author: Andrea Galvis MD*

Co-Author(s): Ivan L Ossma-Gomez MD**Purpose: Long-term visual function and capsular biocompatibility were assessed>4 years after implantation with a dual optic accommodating IOL. Methods: Pro-spective non-controlled longitudinal study; testing included visual acuities measuredat different distances; slit lamp exam, reading speed and UBM to demonstratemechanism of action. Results: Uncorrected visual acuity (UCVA) was 20/40 or bet-ter for distance and intermediate for all subjects while 88% achieved 20/40 nearUCVA. Yag rates were 5.8%. Ultrasound biomicroscopy analysis showed evidenceof movement after accommodative stimuli. Conclusion: The dual optic accommo-dating IOL provides patients with adequate near, intermediate and distance visionthat is maintained for over 4 years.

9:37 AMPanel discussion of previous paper

PA160 9:40 AMFunctional Range of Vision After Binocular Implantation of Multifocal or Dual Optic Accommodating IOLsPresenting Author: Ivan L Ossma-Gomez MD*

Co-Author(s): Andrea Galvis MD**, Victor Manuel Bohorquez MD**, Ricardo Alarcon MD**Purpose: To compare range and quality of vision after binocular implantation withtwo intraocular lens (IOL) technologies. Methods: Multicenter randomized prospec-tive double masked clinical trial comparing patients binocularly implanted with dualoptic accommodating IOLs (N = 44) or diffractive apodized multifocal IOLs (N = 48).Results: There were statistically significant differences in mean acuities at 60through 200 cm. Contrast sensitivity showed differences at all frequencies in all light-ing conditions (P<0.01). Conclusions: Patients implanted with a dual opticaccommodating IOL achieve better intermediate visual acuities compared to similarpatients implanted with multifocal diffractive apodized IOLs with higher levels of visualquality.

9:47 AMPanel discussion of previous paper

PA161 9:50 AMReal Life Performance of Dual Optic Accommodating and Multifocal IOLsPresenting Author: Andrea Galvis MD*

Co-Author(s): Ivan L Ossma-Gomez MD**Purpose: To describe reading speed and visual function under different lightingconditions comparing 4 intraocular lens (IOL) technologies. Methods: Non-concur-rent comparative study of 4 patient groups implanted with Synchrony (N = 29),Tecnis Multifocal (MF) (N = 34), ReSTOR (N = 27) and ReZoom (N = 30). Readingspeed was measured under photopic and mesopic conditions. Results: Mesopicreading speeds were higher in the Tecnis MF (164.3 ± 27.6) and Synchronygroups (159.6 ± 19.8) compared to ReZoom (86.9 ± 11.5) and ReSTOR (75.2 ±12.1) (P < .0001). Contrast sensitivity function was highest in Synchrony group.Conclusion: Dual optic accommodating IOLs showed high performance in readingspeed while providing higher quality of vision when compared to MF IOLs.

9:57 AMPanel discussion of previous paper

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PAAO Original Papers

* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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Cornea, External Disease

Sunday, Oct. 253:15 - 4:15 PM

SOUTH, Room 236

PA124 3:15 PMConjunctival vs. Limbal-Conjunctival Autograft in Primary Pterygium Surgery: Do Limbal Cells Make a Difference?Presenting Author: Olga Alvarez-Bulnes MD

Co-Author(s): Maria Teresa F Sellares MD**, Alfons Casale MD**, Xavier Nunez MD**, Josep Visa Nasarre MD**, Manuel Alejandro Romera MD**, Josep Gracia Martinez MD**Purpose: To determine whether limbal cells have a role in the prevention of recur-rence after primary pterygium surgery. Methods: Revision of 36 eyes with primarypterygium. 18 underwent excision with conjunctival autograft, whereas the restunderwent excision with limbal-conjunctival autograft. All of them were followed forone year. Results: 2 patients in the conjunctival graft group (11%) presented recur-rence after 12 months, while none of the patients in the other group had recurrence.However, no statistical difference was found between the two types of autograft (P =0.2). Conclusion: The results suggest that the barrier effect of the graft, not thelimbal cells themselves, plays a role in reducing recurrences after primary pterygiumsurgery.

3:22 PMPanel discussion of previous paper

PA125 3:25 PMMicrobial Keratitis in the Elderly: A 32-Year ReviewPresenting Author: Renato Passos

Co-Author(s): Angelino Julio Cariello MD**, Maria Cecíia Zorat-Yu PhD**, Ana Hofling-Lima MD MBAPurpose: To describe 1545 cases of microbial keratitis in the elderly in a referenceservice. Methods: Revision of files from elder patients with microbial keratitis thatunderwent corneal scraping for microbiological analysis. Results: Most prevalentage group was 60–69 years (46.8%). There were 681 males (45.8%). Associatedfactors were: past ocular surgery (25.1%), ocular trauma (7.2%), and contact lensusage (3.0%). Bacterioscopy was positive in 40.5% of cases. Culture positivity forany agent was 53.5% (bacteria 47.0%, fungi 6.1%, Acanthamoeba 0.4%). Con-clusion: The most important associated factor was past ocular surgery, especiallypenetrating keratoplasty. The most frequent causative agents were bacteria: Gram-positive cocci (coagulase negative Staphylococcus) and Gram-negative bacilli (Pseu-domonas,Proteus, and Moraxella).

3:32 PMPanel discussion of previous paper

PA126 3:35 PMAnalysis of Intraocular Pressure After Corneal Collagen Crosslinking in Patients With KeratoconusPresenting Author: Maria Jose Cosentino MD

Co-Author(s): Daniel A Badoza MDPurpose: To analyze changes in IOP in eyes with keratoconus after corneal cross-linking (CXL). Methods: We studied retrospectively 45 cases operated on withCXL. IOP was measured with Goldmann applanation tonometry (GAT) before and 12months after CXL. Preoperative flattest K was 47.61 ± 6.48 D, steepest K was51.10 ± 8.48 D, and IOP was 12.5 ± 2.96 mm Hg. Results: Twelve monthsafter CXL, flattest K was 45.33 ± 6.35 D and steepest K was 48.79 ± 7.91 D; IOP

decreased to 10.93 ± 3.52 mm Hg (P < .001). Conclusion: Small but statisti-cally significant reductions in IOP measurements with GAT were found after CXL inpatients with keratoconus. The rationale for this effect might be the reduction in ker-atometric values after CXL.

3:42 PMPanel discussion of previous paper

PA127 3:45 PMBacterial Resistance to Moxifloxacin Prophylaxis in Photorefractive Keratectomy (PRK) PatientsPresenting Author: Maria C Leoratti MD

Co-Author(s): Mauro S Campos MDPurpose: To evaluate moxifloxacin prophylaxis in patients submitted to PRK.Methods: 80 eyes were randomized to receive topical moxifloxacin 0.5% (MOX)(G1) or hipromelose (G2) qid during 3 days before and MOX for7 days after surgery.Conjunctival scrapings were collected before surgery (TI-3days and TII-30 minutes)and postoperatively (TIII-7 and TIV-30 days) for cultures. Results: Cultures weresimilar at TI. At TII, a significant number of eyes from G1 had negative cultures (P <.001) but no differences were found at TIII or TIV (P > .005),3 eyes from G1 dis-closed methicillin-resistant Staphylococcus during the study. Conclusion: MOXreduced the conjunctival bacterial flora but its prolonged use may facilitate the selec-tion of resistant microorganisms or to induce bacterial mutation.

3:52 PMPanel discussion of previous paper

PA128 3:55 PMAutomated Lamellar Disc Keratectomy for the Treatment of Disabling Symptoms in Bullous KeratopathyPresenting Author: Eliana D Goncalves MD**

Co-Author(s): Fabiana Paris**, Ricardo Kanecadan MD**, Jose Gomes MD*, Mauro S Campos MDPurpose: To evaluate the effects of automated lamellar disc keratectomy (ALDK) forthe treatment of painful bullous keratopathy (BK). Methods: Twenty nine patientswere randomized to ALDK alone (G1) or with adjunctive intra operative 0.02% mito-mycin C (G2). All patients were followed for 6 months and 23 completed one year offollow up. Pain was quantified by means of a 1 (less) to 10 (maximum) grading sys-tem, number and duration of episodes and insomnia due to night pain. Results:Mean pain reduced from 8,2 (G1) and 7,4 (G2) preoperatively to 1,8(G1, P= .001)and 1,0 (G2, P< .001) at one year. Of the 12 patients with preoperative insomnia,none presented this symptom during the study. Conclusion: ALDK is an effectivetherapy for controlling pain in BK.

4:02 PMPanel discussion of previous paper

PA129 4:05 PMTrends on Gram Positive Microbial Keratitis in South FloridaPresenting Author: Roberta de Ventura Urbano MD

Co-Author(s): Eduardo C Alfonso MD*, Darlene Miller MPHPurpose: to evaluate the trends on the gram positive microbial keratitis infectious onSouth Florida. Methods: laboratory records of patients examined at our institutionbetween 1990 and 2008 , were divide in four periods separated by years. Data wasextracted on culture positive rates, pathogen frequency , emerging antibiotic resis-tance. Results: the culture positive rate was stable through all four periods. Onperiod C an increase on the resistance profile was shown. Conclusion: It is not onlyimportant to monitor the resistance profile of microbial keratitis , but it is also impor-tant to establish the trends on the microbial pathogen profile and to update the trendsrelated to the risk factors.

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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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4:12 PMPanel discussion of previous paper

Monday, Oct. 262:00 - 3:00 PM

SOUTH, Room 238

PA150 2:00 PMCirugía Corneal de Adición en Ectasia Post-LASIKPresenting Author: Pedro-Ivan Navarro MD

Objetivo: El implante de segmentos intracorneales podría ser una opción quirúrgicanovedosa y segura para tratar la ectasia post-lasik. Métodos: Presentamos el resul-tado de doce ojos tratados con intacs que fueron seguidos durante 36 meses paraobservar su efectividad terapeútica. Resultados: El tiempo promedio de diag-nóstico de la enfermedad fue 42.33 meses, la agudeza no corregida acumuladapreoperatoria mostró que el 100% de los pacientes tenía una visión de 20/400 opeor y de 20/70 o mejor en el post-operatorio a 3 años. Todos los pacientesmostraron aplanamiento corneal y reducción en el defecto refractivo desde un mesde operados, los cuales se mantuvieron en el tiempo. Conclusión: Cirugía cornealde adición con intacs puede ser un procedimiento novedoso y mínimamente invasivopara tratar la ectasia corneal post-lasik.

2:07 PMPanel discussion of previous paper

PA151 2:10 PMResultados de Queratoplastia Penetrante en el Centro Cristiano de Servicios MedicosPresenting Author: Robin A Rios MD

Objetivo: Evaluar los resultados de queratoplastías penetrantes realizadas entre elaño 2000 al 2007. Método: Estudio retrospectivo de 103 pacientes sometidos aqueratoplastía, valorando indicaciones preoperatorias, resultados visuales, edad deldonante y complicaciones. Resultados: Los principales diagnósticos etiológicosfueron queratitis microbiana (33.3%) y queratopatía bullosa (22.2%) Los mejoresresultados visuales fueron queratocono (86%) y distrofia de Fuchs (80%). Huborechazo del injerto en 16 ojos (14.8%). No hubieron diferencias significativas poredad del donante. Conclusión: La queratitis microbiana activa cursa con pobrerecuperación visual después de trasplante corneal. Es válido usar tejidos dedonantes mayores de 65 años.

2:17 PMPanel discussion of previous paper

PA152 2:20 PMSegmentos en Ectasias Secundarias a Cirugia RefractivaPresenting Author: Ricardo L Escobar Cuartas SR MD

Objetivo: Demostrar las bondades de una técnica mínimamente invasiva, de rápidarecuperación y de alta satisfacción para el médico y el paciente. Con mejoría evi-dente de la AV, del patrón topográfico y estable en el seguimiento. Métodos:Pacientes con ectasias posteriores a cirugías incisionales y / o excimer láser. Utili-zando una Z.O. de 5 mm y los segmentos de Ferrara y / o keraring. Resultados:Se muestra la mejoría de la AV sin y con corrección, la seguridad de la técnica, lastopografías pre y pos operatorias con seguimientos de 6 meses a 5 años. Conclu-sión: Los segmentos intraestromales son una excelente alternativa en el manejo delas diferentes ectasias, con muy baja tasa de complicaciones, estable y no contrain-dica otras cirugías en el futuro.

2:27 PMPanel discussion of previous paper

PA153 2:30 PMCambios Refractivos a 4 Años en Pacientes con Queratocono Operados con Anillos de Ferrara/Keraring (AF)Presenting Author: Francisco Segura-Lozano MD

Co-Author(s): Gabriela Bustamante MD**, Laura Elena Valencia MD**, Leonard Zuniga**Objetivo: Ver la eficacia de los AF a 4 años de control en pacientes con ectasiascorneales. Método: 75 pacientes con Queratocono QC y otras ectasias fueronimplantados con AF midiéndoles la agudeza visual sin y con corrección (AVSC,AVCC) refracción y queratometrías (Q1,Q2) preoperatorias y a 1,2,3 y 4 años.Resultados: Todas las variables mejoraron significativamente a 1 año. AVSCmejoró de 20/180 a 20/60, AVCC de 20/40 a 20/30, Esfera de -8.7 a -3.6,Astigmatismo de 5.6 a 2.8, Q1 de 54.1 a 47.9, Q2 de 47.9 a 45.9 P < 0.001).Al comparar estos resultados con las mediciones subsecuentes no hubo diferenciassignificativas (P > 0.1) Conclusión: Los AF mejoran significativamente la visión depacientes con QC, disminuyendo la refracción y aplanando Q1 y Q2. A 4 años decontrol estos cambios siguen estables.

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PA154 2:40 PMVision-Related Quality of Life in Keratoconus Patients Treated for Corneal Collagen CrosslinkingPresenting Author: Ricardo Gomes dos Reis MD

Co-Author(s): Ricardo Lamy MD*, Bruno M Fontes MD*, Camila F Netto MD**, Mariana G Pecego MD**, Lorena Vianna**, Haroldo V Moraes Jr MD, Adalmir M Dantas MD**Purpose: Evaluate the vision-related quality of life in keratoconus patients treatedwith riboflavin and ultraviolet radiation for Corneal Collagen Cross-linking (CXL).Methods: The National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25)was applied in twenty-one patients with progressive keratoconus treated by CXL. Thequestionnaire was applied before and after the procedure, with ranges of 3, 6 and12 months. Results: The NEI-VFQ-25 composite score increased 5.3 points after3 months (P < .05); 4.2 points after 6 months (P < .05) and 5.4 points after 12months (P < .05). Conclusion: The vision-related quality of life had a generalimprovement after crosslinking treatment.

2:47 PMPanel discussion of previous paper

PA155 2:50 PMEffects of Corneal Collagen Crosslinking on Visual Acuity and Contrast SensitivityPresenting Author: Ricardo Lamy MD*

Co-Author(s): Camila F Netto MD**, Ricardo Gomes dos Reis MD, Bruno M Fontes MD*, Mariana G Pecego MD**, Lorena Vianna**, Haroldo V Moraes Jr MD, Adalmir M Dantas MD**Purpose: Assess the effects of corneal collagen crosslinking (CXL) on visual acuityand contrast sensitivity. Methods: Sixty-two eyes of 31 patients were enrolled. Oneeye was treated and the fellow served as control. Pelli-Robson contrast sensitivity test(PR) and best corrected visual acuity (BCVA) were compared preoperatively and 40,90, 180 and 365 days after cross-linking Results: In the treated group, BCVA (log-MAR) improved (P < .05) after 40 days (-0.08); 90 days (-0.14); 180 days (-016);365 days (-0.18) and PR decreased -0.13 points (P = 0.34) after 40 days andincreased +1.23, +1.81 and +2.35 points after respectively 90, 180 and 365days (P < .05). Conclusion: CXL was efficacious in improving visual acuity and con-trast sensitivity

2:57 PMPanel discussion of previous paper

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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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Tuesday, Oct. 2710:15 - 11:15 AMSOUTH, Room 238

PA193 10:15 AMAmniotic Membrane: Its Effect on the Expression of IL-8 Cytokine Through TLR3 Pathway on Human Limbocorneal CellsPresenting Author: Jonathan U Quevedo Martinez MD

Co-Author(s): Yonathan Garfias MD PhD**, Veronica Zaga MD PhD**, Maricar-men Jimenez-Martinez MD PhD**Purpose: The aim of the study is to identify whether amniotic membrane (AM) iscapable of inhibiting the synthesis and secretion of IL-8 in human limbocorneal cells(HuLC). Methods: Primary cultures of HuLC were stimulated with specific patho-gen-associated molecular patterns (PAMPs) to each toll-like receptor (TLR).Synthesis and secretion of IL-8 was measured by reverse transcription polymerasechain reaction and ELISA. Experiments were performed in the presence or absenceof AM. Results: There was significant increase in IL-8 synthesis in cells incubatedwith Poly (I:C) and ODN2006. A significant reduction in the expression of IL-8 wasobserved in the presence of AM. To determine protein expression of TLR3, intracel-lular flow cytometry on HuLC was performed, and there was no significant change inits expression. Conclusions: We can conclude that AM did not affect the expres-sion of TLR3.

10:22 AMPanel discussion of previous paper

PA194 10:25 AMEvaluation of Conjunctival Flora in Patients With Tear Film DysfunctionPresenting Author: Melissa Tomimatsu**

Co-Author(s): Ana Hofling-Lima MD MBA, Flavio Hirai MD, Manuela M Cordeiro Barbosa MD**Purpose: To evaluate the conjunctival flora of patients with tear film dysfunction andits modification after silicon plug insertion. Methods: Cross-sectional study of 41patients, from UNIFESP, São Paulo, from 2005 to 2007. Samples were taken fromconjunctival sac and tested for the presence of microorganisms before and after pluginsertion. Results: Coagulase-negative Staphylococcus was the most prevalentmicroorganism in eyes with or without plug. Susceptibility to oxacillin before and afterplug insertion was 87.5% and 73.7%, respectively. Conclusion: Conjunctival floraof eyes with tear film dysfunction was similar to that in normal eyes. Specific prophy-laxis before intraocular surgery in patients with plugs might not be necessary.

10:32 AMPanel discussion of previous paper

PA195 10:35 AMEndothelial Cell Loss (ECL) in Busin Glide (BG) vs. Forceps-Assisted (FA) Donor Lenticule Insertion Technique for DSEKPresenting Author: Dominika Anna Janiszewska MD**

Co-Author(s): Dariusz Dobrowolski MD**, Dorota Tarnawska MD, Edward A Wylegala MD PhD**Purpose: To compare endothelial cell loss (ECL) after Descemet-stripping endothe-lial keratoplasty (DSEK) with 2 graft insertion techniques. Methods: Cross sectional,longitudinal retrospective analyses of 86 patients after DSEK, 40 operated usingBusin glide (BG) and 46 with forceps-assisted (FA) technique. Endothelial cell densitywas measured with Topcon SP 3000 and CSO SP-02 (agreement assessed withBland-Altman method). Measurements obtained preoperatively and at 6 and 12months postoperatively were compared. Results: There was no statistical differencebetween ECL from BG and FA at 6 months (P = .76). ECL was significantly greaterthan BG at 12 months (P = .011). Conclusion: There is an acceleration of ECLfrom 0.5 to 1 year postoperatively, significantly lower in the BG technique.

10:42 AMPanel discussion of previous paper

PA196 10:45 AMEffect of Crosslinking on Corneal Thickness in Patients With Corneal EdemaPresenting Author: Manuela M Cordeiro Barbosa MD**

Co-Author(s): Ana Hofling-Lima MD MBA, Jose Bonifacio Barbosa JR MD**, Flavio Hirai MDPurpose: To investigate the effects of collagen crosslinking in corneal thickness ofpatients with corneal edema. Methods: Clinical interventional case series included25 eyes of 25 consecutive patients with corneal edema for at least 4 months. Thecorneal thickness was measured in microns before and 1, 3, and 6 months after thetreatment utilizing ultrasound pachymetry (UP) and OCT. Results: The media ofpretreatment for UP 712 μm and OCT 773 μm, reduction of corneal thickness, wasmeasured in all postoperative data; 1 month: 618 μm, 712 μm; 3 months: 657 μmand 746 μm. Conclusion: Collagen crosslinking may be an alternative to reducecorneal edema.

10:52 AMPanel discussion of previous paper

PA197 10:55 AMHypertonic Saline Solution Versus Diluted Alcohol-Histological, Ultra-microscopical and Immunohistochemical Study of Corneal EpitheliumPresenting Author: Rossen M Hazarbassanov MD

Co-Author(s): Myrna Santos MD**, Edna Freymuller MD**, Jose Gomes MD*Purpose: To determine alterations on keratoconus corneal buttons (KCB) epitheliumexposed to ethanol 20% (ET) or 5%, 10%, 20% hypertonic saline (HS). Methods:Ten KCBs were exposed to ET or HS for 30 seconds and evaluated by microscopy,ultramicroscopy (UM), and immunohistochemistry (caspase-3). Results: Corneasexposed to ET and 20% HS showed epithelium and basal membrane damage. UMrevealed uniform desmosomal junctions and low electronic density between epithelialcells and epithelium and BL for ET-treated samples. On 10% HS treatment therewas shrinking and detachment of all epithelium layers. No condition showed stainingfor caspase-3. Conclusion: Cornea exposure to HS (5%, 10%) causes less dam-age to epithelium than similar exposure to 20% HS or 20% ET.

11:02 AMPanel discussion of previous paper

PA198 11:05 AMPredictive Model to Calculate Glaucoma Development Risk in Penetrating KeratoplastyPresenting Author: Blanca Domingo-Gordo MD PhD**

Co-Author(s): Beatriz Paredes-Garcia MD PhD**, Dolores Martin MD**, M Jesus Herrero-Lluch MD**, Carlos Salvador Fernandez Escamez MD, Nicolas Tole-dano Fernandez MD**Purpose: To determine glaucoma postkeratoplasty incidence and risk factors.Methods: 348 patients were analyzed prospectively with univariate and multivariatemethods to reach a predictive model. Results: Glaucoma incidence was 25%,increased in perforation (RR: 1.9), trauma (RR: 1.8), bullous keratopathy (RR: 1.7),prior glaucoma (RR: 4.1), pseudophakia with anterior chamber IOL pre-PK (RR:3.9), pseudophakia with posterior chamber IOL post-PK (RR: 2.3), IOL removal (RR:3.3), aphakia post-PK (RR: 3), interrupted sutures (RR: 1.9), and peripheral syn-echiae (R: 10.8). We reached a predictive model with a accuracy of 83.8% todetect probability of glaucoma development. Conclusion: A predictive modelmight calculate individual risk to develop glaucoma that causes important visualimpairment.

11:12 AMPanel discussion of previous paper

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Intraocular Inflammation, Uveitis

Sunday, Oct. 252:00 - 3:00 PM

SOUTH, Room 236

PA110 2:00 PMBevacizumab Intravitreo Versus Acetonida de Triamcinolona Intravitrea Para el Edema Macular Cistoideo Uveitico Refractario (EMCUR)Presenting Author: Andr Francisco Lasave MD

Co-Author(s): Juan G Sanchez MD, Lihteh Wu MD, Mauricio Maia MD, Arturo A Alezzandrini MD**, Miguel E Brito MD**, Humberto Contreras-Brandt MD**, Sergio Bonafonte**, Silvio M Lujan MD**, Manuel Diaz Llopis MD PhD**, Natalia Restrepo MD**, Francisco J Rodriguez MD*, Patricia Udaondo MD**, Juan V Espinoza-Garcia MD, J Fernando Arevalo MD FACSObjetivo: Reportar la eficacia de la inyección intravítrea única de bevacizumab (BIV)versus acetonida de triamcinolona intravitrea (TIV) para tratar el EMCUR no infecci-oso. Métodos: 28 pacientes (36 ojos) recibieron una inyección de BIV 2.5 mg (16ojos) o 4 mg de TIV (20 ojos). Resultados: Seguimiento fue de 6 meses. El GrupoTIV tenia una agudeza visual (AV) basal logMAR 1.1 ± 0.2 y 0.7 ± 0.4 (P < .001)a los 6 meses. El Grupo BIV tenia una AV basal logMAR 1.2 ± 0.4 y 0.8 ± 0.4 (P= .02) al final del seguimiento. El Grupo TIV presento una reducción significativa delEMC por OCT desde 454.8 ± 238.9 μm a 296 ± 134.4 μm en 6 meses (P <.001). El Grupo BIV no presento diferencias significativas. Conclusión: Una inyec-ción única de TIV fue más efectiva que el BIV en 6 meses en EMCUR.

2:08 PMPanel discussion of previous paper

PA111 2:12 PMToxocariasis Ocular en Costa Rica 1998–2008: Una Revisión de 10 AñosPresenting Author: Roberto Jimenez MD**

Co-Author(s): Lihteh Wu MD, Joaquin Martinez MDObjetivo: Describir las características clínicas de la toxocariasis ocular en CostaRica. Métodos: Revisión retrospectiva de todos los casos diagnosticados con toxo-cariasis ocular durante los años 1998-2008 en el Hospital Nacional de Niños.Resultados: 80 casos fueron identificados. En promedio, los pacientes se exam-inaron 6.7 meses después del inicio de síntomas. Los síntomas de presentaciónmás comunes eran estrabismo, pérdida visual y leucocoria. A la presentación el92.5% tenía una AV menor o igual que 20/200. Al finalizar el seguimiento, el18.5% de los ojos obtuvo una AV mayor o igual que 20/40, 13% entre 20/50 y20/100 y 68.5% tenían menor o igual que 20/200. Conclusión: En Costa Rica,el diagnóstico de una toxocariasis ocular es muy tardío por lo cual los resultadosvisuales son pobres.

2:20 PMPanel discussion of previous paper

PA112 2:24 PMIncidencia de Uveítis en Costa RicaPresenting Author: Ana Maria Munoz Barrionuevo MD

Co-Author(s): Lihteh Wu MDPropósito: Determinar la incidencia y características clínicas de uveítis en un centrooftalmológico terciario en Costa Rica. Métodos: Se evaluaron prospectivamente losnuevos pacientes en el Consultorio de Emergencias de Oftalmología del HospitalMéxico de Abril 2008 a Marzo 2009. Resultados: Se evaluaron 1368 pacientes,de los cuales 34 (2.5%) presentaron uveítis de nueva presentación, 22 pacienteseran masculinos y 12 femeninas con edad media de 35.2 años (rango de 15 a 82

años). La presentación más frecuente fue 52.9% panuveitis, seguida de posterior(26.5%) y anterior (20,6%) Se documentó curso agudo en 70%, unilateralidad en91.2% y 56% causadas por toxoplasmosis. Conclusión: La incidencia de uveítisen Costa Rica en un centro terciario es 2.5%.

2:32 PMPanel discussion of previous paper

PA123 2:36 PMIntravitreal Bevacizumab (IVTB) for Inflammatory Choroidal Neovascularization (CNV): Results From a Collaborative Study GroupPresenting Author: Juan V Espinoza-Garcia MD

Co-Author(s): Maria H Berrocal MD*, Mauricio Maia MD, Lihteh Wu MD, Jose A Roca MD, Hugo Quiroz-Mercado MD*, Jose M Ruiz-Moreno MD PhD, Andr Francisco Lasave MD, J Fernando Arevalo MD FACSPurpose: To evaluate the safety and efficacy of intravitreal bevacizumab (IVTB) ininflammatory CNV. Methods: Retrospective, multicenter, interventional, noncom-parative study of 11 eyes (10 patients) with CNV secondary to chorioretinalinflammatory diseases treated with IVTB (1.25 mg or 2.5 mg) and followed for 24months. Results: At 24 months after IVTB, logMAR BCVA improved from 0.82 to0.53 (P < .05), and central macular thickness (CMT) decreased from 344.3 μm to201.2 μm (P = .004). BCVA remained stable (± 1 lines) or improved 2 or morelines in 9 eyes (81.8%). Reinjections were necessary in 5 eyes (45.5%). Conclu-sion: IVTB seems to provide functional and anatomic stability or improvement ininflammatory CNV at 24 months.

2:44 PMPanel discussion of previous paper

Ocular Tumors and Pathology

Sunday, Oct. 2510:15 - 11:15 AMSOUTH, Room 238

PA168 10:15 AMInfiltración del Cristalino por Melanomas Uveales. Características Inmunohistoquímicas e Implicaciones ClínicasPresenting Author: David E Pelayes MD

Co-Author(s): A Martin Folgar MD**, Jorge Zarate MD**Objetivo: Reportar la infiltración del cristalino por los melanomas intraoculares.Describir las características inmunohistoquímicas e implicancias clínicas. Materia-les y metodos: Se estudiaron 4 casos que en el momento del diagnóstico clínico,ecográfico, mostraban compromiso del cristalino. Todos fueron evaluados mediantetécnicas convencionales e inmunohistoquímicas. Resultados: Dos pacientesmostraron compromiso capsular y del epitelio del cristalino. Los otros 2 casos com-prometían las fibras periféricas y lo rodeaban totalmente. En los 4 casos, el tipohistológico era mixto, de predominio epiteloide. Conclusión: Los melanomas intra-oculares raramente infiltran el cristalino. Esto depende fundamentalmente de suubicación y de su agresividad histológica.

10:23 AMPanel discussion of previous paper

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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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PA169 10:27 AMConjunctival Tumor in Hispanic Population: 100 Chilean Patients Clinical SeriesPresenting Author: Maria E Manquez Hatta MD

Co-Author(s): Pablo Vigorena MD**Purpose: To describe a series of conjunctival tumors in Hispanic population.Methods: Clinical follow up in 100 consecutive patients sent to a referral center.Chile from April 2006 to April 2009. Results: Of the 100 hispanic patients 90%were adults, there was no difference by sex. Bening lesions were 67% mostly con-junctival nevus, malignant lesions were 33% including squamous cell carcinoma,melanoma, lymphoma, sebaceous carcinoma. Melanocytic lesions were 71 %, nonmelanocytic lesions were 29%. Conclusion: The conjunctival tumors are present inhispanic patients from different ages. Most of the tumors are benign lesions. Thepresence of malignant tumors is not an exception.

10:35 AMPanel discussion of previous paper

PA170 10:39 AMExpression of Hipoxia Inducible Factor-1 in Uveal Melanoma Animal Model Treated With COX-2 InhibitorPresenting Author: Alexandre Nakao Odashiro MD

Co-Author(s): Patricia Odashiro**, Sebastian Di Cesari MS**, Daniel Abourbih MS**, Emilia Antecka MD PhD**, Priscila Inacio Fernandes MD**, Bruno Franco Fernandes MD PhD**, Miguel N Burnier Jr MD PhD**Purpose: To describe differences of HIF-1 expression in uveal melanomas (UM)treated and nontreated with COX-2 inhibitors. Methods: Paraffin blocks from intra-ocular UM of the COX-2 animal model were selected. Four tumors from the treatedand 7 from the control group were immunostained for HIF-1- protein. Tumorswere classified 0, 1, 2, or 3 according to the staining. Results: In the controlgroup, 85.7% of tumors presented a score of 3, and 14.3% presented a score of2. In the treated group, 75% presented a score of 1, and 25% presented a score of2 (P = .000216). Conclusion: The effect of COX-2 inhibitors in UM can be relatedto the reduction of the hypoxia.

10:47 AMPanel discussion of previous paper

PA171 10:51 AM15-Lipoxygenase Expression in Uveal MelanomaPresenting Author: Andresson M Figueiredo MD PhD

Co-Author(s): Paulo C Ferreira MD PhD, Gustavo S Lima MD**, Fernando Ram-alho Lopes MDPurpose: To investigate the expression of the platelet isoforms of 15-Lipoxygenase(15-LOX) in uveal melanoma and its correlation with histopathological prognosticfactors. Methods: Immunohistochemistry for 15-LOX was done in 20 cases ofuveal melanoma. The 15-LOX expression was related to histopathological prognosticmarkers, such as cell type, the presence of lymphocytic infiltration and vascularclosed loops in the tumour. Results: 15-LOX expression was found in 13 (65%) ofthe cases, and it correlated with markers of poor prognosis. such as epithelioid celltype and the presence of lymphocytic infiltration and vascular closed loops. Conclu-sion: The role of 15-LOX in uveal melanoma should be further elucidated, and theuse of 15-LOX inhibitors warrants investigation as therapeutic target for chemopre-vention of melanoma metastasis.

10:59 AMPanel discussion of previous paper

Orbit, Lacrimal, Plastic Surgery

Sunday, Oct. 254:30 - 5:30 PM

SOUTH, Room 236

PA130 4:30 PMTratamiento Con Dosis Bajas de Radioterapia en la Orbitopatía TiroideaPresenting Author: Virginia Bautista Ruescas**

Co-Author(s): Maria Mercedes Lopez Molina, Jose Manuel Ortiz Egea MD**, Maria Mercedes Lopez Molina, Maria Jose Carrilero Ferrer MD**Métodos: Presentamos una serie de diez pacientes con oftalmopatía activa mod-erada-severa tras tratamiento radioterápico externo con megavoltaje yfraccionamiento de 1 Gy/semanal 20 semanas. Utilizamos una escala de satisfac-ción entre 1 nula y 5 excelente. Resultados: El 80% dio una respuesta superior oigual a 4 tras finalizar y a los 6 meses. La clínica inflamatoria disminuyó en todos yse normalizó la motilidad ocular en los casos afectos. Los efectos secundariosfueron en tres casos edema palpebral, dos casos de alopecia en cejas, y tres casoscon leves molestias retro-oculares desapareciendo a la semana. Conclusión: Lamotilidad ocular, la pérdida de agudeza visual y la inflamación es mejorada conradioterapia y corticoides. Administrando 1 Gy por semana, se logra una respuestasimilar con menos efectos secundarios.

4:38 PMPanel discussion of previous paper

PA131 4:42 PMSphenoid Wing Meningioma Resection Through an Extended Eyelid Crease Approach to the Temporal Cranial FossaPresenting Author: Alfio P Piva MD**

Purpose: To demonstrate that sphenoid orbital meningioma (SOM) resection ispossible through a pure orbital route. Methods: Prospective, noncomparative 6-patient case series description of surgical technique. Study included SOM limited tothe sphenoid wing with or without adjacent intradural infiltration or compressive opticneuropathy (CON). SOM resection was accomplished through extended eyelidcrease incision using standard microsurgical drilling techniques. Meningioma infil-trated bone was directly drilled out, exposing duramater and periorbita. Results:Gross total meningioma resection was possible in all cases. Average reduction ofexophthalmos = 3.66 mm (3–5 mm), SD ± 0.81. Improved CON: 3/4. Conclu-sion: The herein described procedure is a suitable way to resect limited SOM with orwithout CON.

5:00 PMPanel discussion of previous paper

PA132 5:04 PMCorrelation Between Refractive Error, Axial Length and Exophthalmometry in Chinese Graves Disease Patients and Normal SubjectsPresenting Author: Jonathan C H Ho MRCP

Co-Author(s): Simon T C Ko MBBS FRCS**, Edwin Chan MBBS**, Clement W N Chan MBBS FRCOphth**Purpose: To study the correlation between refractive error (spherical equivalent [SE]during analysis), axial length (AL), and exophthalmometry (EV) in Chinese Graves dis-ease (GD) and normal subjects. Methods: Eighty-two GD and 82 normal, sex- andage-matched subjects were recruited with measurements obtained. Results: EV inGD group (24.11 mm) was higher than that in the normal group (21.70 mm). Cor-relations between EV and AL were 0.45 (Pearson r) for normal; 0.33 for GD; EV vs.

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SE: r = 0.29 for normal; 0.19 for GD. Correlation between AL and SE was good inboth groups: r = 0.94, normal; 0.77, GD. Conclusion: A lower level of correlationis found between EV vs. AL and EV vs. SE in normal subjects, as compared to previ-ous literature. The correlations are even less in GD individuals.

5:12 PMPanel discussion of previous paper

Pediatric Ophthalmology, Strabismus

Sunday, Oct. 253:15 - 4:15 PM

SOUTH, Room 238

PA175 3:15 PMEvolution of Hyperopia in Accommodative Esotropia PatientsPresenting Author: Ofelia M Brugnoli De Pagano MD

Co-Author(s): Myriam Berman MD, Gabriela Lucia PaganoPurpose: To study the evolution of hyperopia in children with accommodative eso-tropia. Methods: 56 eyes of 28 patients were examined under cycloplegia withcyclopentolate hydrochloride 1% and measured with autorefractor annually. Mean (±SD) starting age was 3.86 (1.86) years old. Mean (± SD) finishing age was 9.64(2.77) years old. Mean follow up period: 5.75 (2.65) years. Mean uncorrected eso-tropia was 28.04 (6.98) DP. Results: Mean Initial Hyperopia was 4.40 (1.70) Dand mean Final Hyperopia 4.42 (1.76) D. No statistically significant difference wasnoted for the group (P > .05). Conclusion: In the light of our study, we believe thathyperopia in patients with refractive accommodative esotropia remains stable throughtime, in contrast to common belief.

3:23 PMPanel discussion of previous paper

PA176 3:27 PMEarly Lensectomy With PC IOL and Capsular Tension Ring (CTR) in Microspherophakia to Avoid Lens-Induced ComplicationsPresenting Author: Ibrahim A Al-Jadaan MD**

Co-Author(s): Ibrahim AlJadaan MD**, Jose Morales MD**Purpose: To report the outcome of early lens aspiration (LA) with posterior chamberIOL (PC IOL) and capsular tension ring (CTR) in microspherophakia (MS) to avoid ortreat lens-induced complications (LIC). Methods: Twelve eyes of 9 patients with amean age of 18 years (range: 9–35) underwent LA with PC IOL and CTR. All eyeshad shallow or absent anterior chamber (AC), frequent lens subluxation, glaucoma,iris corneal touch, and lens-induced myopia. Results: Ten of 12 eyes that had earlysurgical intervention ended with ≥ 20/40 vision, normal IOP, deep AC, stable IOL,and emmetropia with a mean follow-up of 5 years (range: 0.3–9). Two eyes devel-oped corneal decompensation due to late presentation and extensive iris cornealtouch. Conclusion: Early surgical intervention in MS is recommended to treat LICand prevent corneal decompensation.

3:35 PMPanel discussion of previous paper

PA177 3:39 PMIs There an Increased Incidence of Higher Order Aberrations in Young Patients With Unilateral Amblyopia?Presenting Author: Alberto Lopez Miguel

Co-Author(s): Miguel J Maldonado MD PhD, Juan C Nieto DO, Arnaldo Bel-zunce MD**, Jesus Barrio MD**Purpose: To investigate the whole eye’s higher-order aberrations (HOAs) in patientswith unilateral strabismic or anisometropic amblyopia. Methods: Ocular HOAs weremeasured with a Hartmann-Shack wavefront sensor over a 6mm pupil in 47 ambly-opic eyes (36 anisometropic and 11 strabismic) and were compared with soundfellow eyes. Results: Mean total third-order aberration root mean square (RMS) val-ues were statistically significantly higher in amblyopic eyes (P = .04), but nodifference could be found in fourth-order or fifth-order RMS values. Conclusion:The correction of third-order aberrations may be a therapeutic target in the visualrehabilitation of eyes with anisometropic and strabismic amblyopia.

3:47 PMPanel discussion of previous paper

PA178 3:51 PMA Study of Complex Strabismus by MRI Using the IMAGE J ProgrammePresenting Author: Marlene Vogel**

Co-Author(s): Galia Gutierrez**, Carolina Valenzuela**, Alejandra Torres MD**, Dario Vasquez MD**, Patrica Orellana MD**Introduction: MRI image analysis by the IMAGEJ program has allowed us to studythe extraocular muscles (EOM) in complex strabismus. Objective: To study EOMwith Image J. Methodology: We have calculated and compared area, position,and angle of EOM from MRI orbit images from healthy patients, those with acquiredstrabismus in high myopia (MAPE), and those with craniosynostosis (CS). Results:MAPE patients had displacement of the rectus lateral muscles (RLM) and their angleswere higher than the healthy eyes and more severe cases. Patients with CS and Vpattern had a displacement in both RLM. Conclusion: This study allowed us todevelop a surgical plan appropriate to the anatomical alteration. This programallowed measurements of positions of orbital structures.

3:59 PMPanel discussion of previous paper

PA179 4:03 PMCharacteristics of Infant Eye Care With Distinct Socio-Economical Profiles in Two Ophthalmologic Emergency CentersPresenting Author: Camila Ventura MD**

Co-Author(s): Vasco Torres Fernandes Bravo**, Liana O Ventura MD, Carlos Teixeira Brandt MD PhD**Purpose: To describe the characteristics of ophthalmologic care in infants with dis-tinct socioeconomic profiles treated in two ophthalmologic emergency centers(OEC). Methods: All patients < 1 year of age cared for at the OEC of the AltinoVentura Foundation (FAV) and Pernambucos´ s Eye Hospital (HOPE) from January toDecember of 2007 had their medical records reviewed. Results: Total patients:944, FAV; and 432, HOPE. Mean age: 114.0 ± 4.0 days (FAV) and 223.7 ± 8.6days (HOPE). FAV’s patients took ± 26.8 and HOPE’s took ± 7.1 days to look formedical care. Conjunctivitis was diagnosed in 58.4% and 71.1%, respectively.Conclusion: The patients from HOPE were older and looked for medical carefaster. Conjunctivitis was the most frequent diagnosis in both centers.

4:11 PMPanel discussion of previous paper

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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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Monday, Oct. 262:00 - 3:00 PM

SOUTH, Room 236

PA144 2:00 PMResección y Transposición Anterior Unilateral del Oblicuo Inferior en el Tratamiento de HipertropiasPresenting Author: Claudia L Pabon MD**

Co-Author(s): Lisleth Gordon MD**, Ana A Gutierrez MD**, Marisabel Andrade MD**, Maria Alejandra Rodriguez MD**Objetivos: Evaluar el resultado de la corrección de hipertropias mediante la resec-ción y transposición anterior unilateral del oblicuo inferior. Materiales y Métodos:Se incluyen 5 pacientes de sexo femenino con hipertropias a quienes se les realizóresección y transposición anterior unilateral del oblicuo inferior. Todas las pacientestenían cirugía previa de músculos horizontales. Resultados: Todas las pacientesestaban en ortotropia en posición primaria al año de seguimiento. Conclusión: Laresección y transposición anterior del oblicuo inferior unilateral es efectiva en el trata-miento de hipertropias en pacientes con antecedente de cirugías previas de losmúsculos horizontales.

2:07 PMPanel discussion of previous paper

PA145 2:10 PMPerfil Epidemiológico de la Retinopatía del Prematuro en un Hospital Universitario de un País Latinoamericano. En un Periodo de 6 AñosPresenting Author: Alexander Maximiliano Martinez Blanco**

Co-Author(s): Claudia Zuluaga MD**, Milton Guerra Torres MD**Objetivo: Determinar el comportamiento epidemiológico de la Retinopatía del Pre-maturo (ROP) en un periodo de 6 años. Métodos: Se revisaron historias clínicas deprematuros de ≤ 34 semanas de gestación y/o ≤ 1500 gr de peso al nacimiento,valorados por el programa de ROP entre enero de 2002 y diciembre de 2007,revisando presencia de ROP de manejo quirúrgico. Resultados: Se estudiaron1703 historias clínicas donde el 12% tuvo algún grado de ROP y de estos el 54%requirieron cirugía. Entre los pacientes de cirugía el 88% tenía menos de 31 sema-nas y el 82% menos de 1251 gr de peso al nacimiento. La incidencia de ROP demanejo ablativo disminuyó del 16% en el 2002 al 4% en el 2007 (P < .001).Conclusión: La incidencia de ROP de manejo quirúrgico mejoró en el periodo deestudio.

2:17 PMPanel discussion of previous paper

PA146 2:20 PMAnálisis de las Funciones Visomotoras y el Nivel de Inteligencia en Niños con Estrabismo RecurrentePresenting Author: Silvia Moguel Ancheita

Co-Author(s): Luis Porfirio Orozco Gomez MD**, Susana Ramirez Sibaja**, Ser-gio Reyes Pantoja**Objetivo: Analizar las funciones cognitivas posterior al tratamiento de estrabismo.Métodos: Estudio prospectivo en niños con estrabismo recurrente. Se aplicaronpruebas de inteligencia y visomotoras, previos y posterior al tratamiento de estra-bismo. Resultados: Se incluyeron 9 niños, edad: 8.7 años, seguimiento 8 meses.Inteligencias: verbal: 91.1 ± 11, ejecutiva: (IE): 86.7 ± 8, global (IG): 91.4 ± 10.6.Coeficiente de Correlación para IE significativa para estereopsis (-0.2), capacidadvisual y Bender (-0.1). La IG posterior (91 ± 10) fue mejor que el valor pronóstico(88.1, x = 90). Conclusión: Demostramos mejoría de las funciones cognitivas rel-acionadas a la recuperación de binocularidad.

2:27 PMPanel discussion of previous paper

PA147 2:30 PMAlteraciones Neurovisuales y Estrabismo en Pacientes con Esclerosis MúltiplePresenting Author: Paula Morelos Herrera MD**

Co-Author(s): Silvia Moguel Ancheita, Rosa María Negrete Rodriguez MD**, Fabiola Ogaz Gonzalez MD**, Luis Porfirio Orozco Gomez MD**, Sandra Qui-nones Aguilar MD**Objetivo: Demostrar los síntomas neurovisuales y estrabismo en pacientes conesclerosis múltiple (EM). Métodos: Estudio prospectivo de pacientes con EM. Serealizó exploración oftalmológica incluyendo pruebas de Fansworth y HRR. Resul-tados: Se incluyeron 14 pacientes, edad: 38.6 ± 9 años. Conclusión:Capacidad visual: 0.36 logMAR, discromatopsia a línea rojo-verde en 85% de loscasos. Estrabismo en 78% incluyendo skew deviation.

2:37 PMPanel discussion of previous paper

PA148 2:40 PMEstudio Clínico y Genético de Pacientes Mexicanos con Fibrosis Congénita de los Músculos ExtraocularesPresenting Author: Naira C Pereyra-Munoz MD**

Co-Author(s): Claudia Elena Murillo Correa**, Sanjuanita Flores-Limas MD**, Juan Carlos Zenteno-Ruiz MD PhD**Objetivo: Identificar mutaciones en el gen KIF21A en pacientes mexicanos confibrosis congénita de músculos extraoculares (FCMEO). Métodos: Se incluyeron 7pacientes con FCMEO. Se realizó exploración oftalmológica, tomografía compu-tarizada de órbitas y análisis del gen KIF21A mediante PCR y secuenciaciónautomatizada. Resultados: Todos los casos fueron esporádicos. Cuatro pacientesreunían los criterios clínicos para FCMEO tipo1 y los otros 3 no tuvieron una cuadrode FCMEO típica, aunque si fueron diagnosticados como FCMEO por hallazgostomográficos. Se evidenciaron mutaciones puntuales en sólo 2 pacientes, ambos enel codón 954 del gen KIF21A(R954W). Conclusión: La FCMEO tipo 1 es la máscomún y se encontraron las mutaciones del KIF21A en dos pacientes.

2:47 PMPanel discussion of previous paper

PA149 2:50 PMFactores de Riesgo en Exotropia ConsecutivaPresenting Author: Blanca Domingo-Gordo MD PhD**

Co-Author(s): Jose Reche-Sainz**, Carlos Salvador Fernandez Escamez MDObjetivo: Factores en la génesis de exotropias consecutivas. Métodos: Estudioretrospectivo. 270 pacientes con exotropia consecutiva. Evaluando parámetros: lim-itación aducción, defectos refractivos, ambliopía, anisometropía, desviación verticaldisociada (DVD) y síndromes alfabéticos, tiempo tras cirugía de esotropia. Paqueteestadístico SPSS 12.0. Resultados: Significativamente, 94% de las exotropias sepresentó tardíamente (P < .01) , hipermetropía (78%) (P < .01), limitación deaducción (77%), ambliopía (77%) y anisometropía (88%). No significativa DVD, nisíndromes alfabéticos. Formas X mayoritarias 55%. Conclusión: Exotropias con-secutivas aparecieron con mayor frecuencia de forma tardía. La existencia dehipermetropía hipocorregida, se demostró como factor asociado significativamente.

2:57 PMPanel discussion of previous paper

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Potpourri

Monday, Oct. 263:15 - 4:15 PM

SOUTH, Room 236

PA162 3:15 PMNew Considerations on Pupillary Block MechanismPresenting Author: Sebastiao Cronemberger MD

Co-Author(s): Nassim S Calixto MD**, Andre Oliveira de Andrade MD**, Rafael Vidal Merula MD**Purpose: To investigate the pupillary block in occludable angle eyes. Methods: Ina pilot study, we first measured by ultrasound biomicroscopy angle amplitude and iristhickness in 13 acute primary angle closure (APAC) eyes under light and dark condi-tions. Afterward, we measured iris-lens angle (ILA), iris-lens contact distance (ILCD),and anterior chamber depth (ACD) in 32 APAC eyes under light and dark conditionsand before and after laser peripheral iridotomy (LPI). Results: Significant decreasein the angle and significant increase in iris thickness occurred when comparing lightto dark conditions. Significant differences were found in ILA and ILCD: before vs.after LPI in light and dark conditions. ACD did not change. Conclusions: Thedecreasing angle amplitude only corresponds to an increase in iris thickness. Follow-ing LPI, APAC eyes had an increase of ILCD and a decrease of ILA, contradicting thepupillary block theory.

3:22 PMPanel discussion of previous paper

PA163 3:25 PMPatients’ Reasons for Self-Reported Nonadherence to Glaucoma TreatmentPresenting Author: Maria L Veronese Rodrigues MD

Co-Author(s): Lucas Ravagnani Silva**, Eduardo M Rocha MD**, Jayter Silva Paula MD PhD**Purpose: To detect patients’ opinions about the causes for not adhering to glau-coma treatment. Method: Interviews, with application of an open questionnaire, to50 patients with primary open-angle glaucoma (POAG). Results: The reportedcauses of noncompliance were side effects of drugs (24%), lack of informationabout glaucoma (22%), difficulties in understanding information and in patient-doctorcommunication (14%), difficulties in administering the treatment (14%), lack offinancial resources to acquire eye drops (10%), and patients´ beliefs and attitudes(10%). Conclusion: Considering the causes reported, adherence may increasewith education about POAG, improvement in the patient-doctor relationship, andincreased antiglaucoma drug supply.

3:32 PMPanel discussion of previous paper

PA164 3:35 PMCyclodialysis Incidence After Trabeculectomy Performed by Residents Diagnosed by UltrabiomicroscopyPresenting Author: Jesus Arrieta-Camacho MD

Co-Author(s): Gilberto Islas MD**, Gerardo Eliud Valdes-Casas MD**Purpose: To determine cyclodialysis incidence after trabeculectomy surgery diag-nosed by ultrasound biomicroscopy. Methods: A prospective, observational,descriptive study was realized.31 eyes were included, 17 male (54.48%), 14female (45.16%). 4 patients were excluded by incomplete follow up. 2 ultrasoundbiomicroscopy scans were realized in the 1st and 3rd postoperative weeks.Results: We identify cyclodialysis during the first ultrasound biomicroscopy scan in

11 eyes (40.74%). In only 2 cases (18.18%) cyclodialysis was found in the 2ndscan whereas in the other 9 patients cyclodialysis was closed at this time. Conclu-sion: This is the first report of cyclodialysis incidence after trabeculectomy surgeryperformed by residents in Mexican population.

3:42 PMPanel discussion of previous paper

PA165 3:45 PMScreening for Causes of Impaired Vision of a Geriatric Population in Costa Rica’s National Geriatric and Gerontologic HospitalPresenting Author: Sebastian Salas**

Co-Author(s): Rolando Mora MD**, Teodoro J Evans MDPurpose: To detect causes of low vision and blindness in the geriatric population.Methods: Prospective, noninterventional, transversal case series of patients evalu-ated for the first time at the ophthalmology department of the Hospital Nacional deGeriatría from September 2006 to April 2007. Screening included corrected Snellenvisual acuity (VA), biomicroscopy, tonometry (Goldmann), and funduscopy.Results: 164 patients; mean age 75.9 ± 8 years; 60.97% were females. Thirty-nine percent had impaired vision (49% cataract, 21% AMD), 34.56% had low vision(53% cataracts, 20% refractive errors), and 4.3% had legal blindness (43% AMD,14% cataract). Conclusion: Cataract is by far the leading cause of impaired visionin the geriatric population.

3:52 PMPanel discussion of previous paper

PA166 3:55 PMVisual Acuity Screening Skill Development ModulePresenting Author: Alexandre C Taleb MD

Co-Author(s): Chao Lung Wen MD PhD**, Marcos P Avila MD**Purpose: To develop a set of educational tools in basic ophthalmology to create askill development module for visual acuity (VA) screening. Methods: Interactivematerial was produced, based on the development of eye anatomy learning objects(3D computer graphics) and short film contextualization. Results: The VA Modulewas applied to 428 health professionals from Family Healthcare Groups throughoutBrazil. Knowledge acquisition was assessed by a standardized questionnaire, whichwas answered before and after the training sessions. A statistically significant differ-ence (P < .001) was verified in every knowledge group evaluated, suggesting thatthe module improved the knowledge of the course participants. Conclusion: Dueto its interactive structure, this module can be used as a distance learning tool for VAscreening skill development.

4:02 PMPanel discussion of previous paper

PA167 4:05 PMHuman Artificial VisionPresenting Author: Jose Luis Ortigoza Velasco

Co-Author(s): Fernando Martinez Castro MD PhD**, Ellery M Lopez Star MD PhD**Purpose: Since 1960 many attempts have been done in order to develop visualprostheses; most of the devices, supported in the production of phosphenes throughelectrical stimulation are incapable to reconstruct a coherent retinotopic map. Meth-ods: This paper describes the experimental design and psychophysical datanecessary for the construction of a visual sensory substitution prostheses with avibrotactile system. Results: The system locates different bars over the epdiermis toreproduce a point by point matrix, allowing the reconstruction of an image with anexternal device that doesn’t require invasive procedures. Conclusions: This vibro-tactile system is capable of reproducing chromatic gammas, depth and movementperception in 3D- environments.

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4:12 PMPanel discussion of previous paper

Refractive Surgery

Sunday, Oct. 252:00 - 3:00 PM

SOUTH, Room 238

PA172 2:00 PMCirugía Refractiva en Niños, Cuándo y Porqué Est á JustificadaPresenting Author: Gabriel Quesada Larez MD

Co-Author(s): Rodrigo Quesada MDIntroduction: LASIK en niños es poco conocido y no es totalmente aceptado. Eneste trabajo presentamos 3 casos de niños operados a los 12 años de edad y unseguimiento de más de 15 años de evolución. Metodo: Niños que no mejoraron suAV con tratamiento convencional, se sometieron a LASIK. Caso 1: microestrabismo,ambliopia, fijación excentrica, +7 OU. Caso 2: anisometropía OS -8.75. Caso 3:estrabismo acomodativo +5 OU. Resultados: Con 15 años de seguimiento, Caso1: mejoró una línea de AV, +1 OD, +2 OS. Caso 2: OS -0.75. Caso 3: plano OU.Conclusión: El éxito en esta cirugía lo valoraremos cuando la visión obtenida en lainfancia persiste en el adulto sin complicaciones.

2:08 PMPanel discussion of previous paper

PA173 2:12 PMAberrometría Corneal en Casos DifícilesPresenting Author: Ricardo L Escobar Cuartas SR MD**

Objetivo: Revisar resultados, explicar la técnica y consejos prácticos en casos depacientes con cirugías previas o con alto grado de aberraciones. Métodos: Todoslos pacientes fueron operados con cirugías guiadas por aberrometría corneal yexcimer láser de Schwind (Esiris y / o Amaris). Resultados: Se demuestran lasgrandes ventajas de esta tecnología. Conclusión: Las cirugías personalizadas sonindispensables en los casos con alto grado de aberraciones de alto orden.

2:20 PMPanel discussion of previous paper

PA174 2:24 PMExcimer Láser en Hipermetropías Mayores de 3,0 DioptriasPresenting Author: Ricardo L Escobar Cuartas SR MD**

Objetivo: Mostrar los resultados de una cirugía extraocular en pacientes con hiper-metropías de 3,0 a 6,50 dioptrías con y sin astigmatismo, utilizando el LáserSCHWIND ESIRIS y AMARIS guiados por aberrometría corneal. Métodos: Pacien-tes Hipermétropes con o sin astigmatismo, con un seguimiento de 6 meses a 5años, todos operados por el mismo cirujano, flap de 9,0 mm o mayor y bisagranasal. Resultados: Se Muestra la técnica quirúrgica , el análisis Topográfico y losmapas de aberrometría postoperatorios . Se demuestra ; que se puede incurvar lacórnea hasta 50,0 o 51,0 dioptrías sin alteraciones epiteliales y con leves cambiosen las aberraciones de alto orden. Conclusión: El Excimer Láser es una alternativamínimamente invasiva en hipermetropía, segura, modificable y con excelentesresultados.

2:32 PMPanel discussion of previous paper

Tuesday, Oct. 279:00 - 10:00 AM

SOUTH, Room 236

PA185 9:00 AMCorneal Collagen Crosslinking Under Contact Lens Molding in Human Donor EyesPresenting Author: Rafael I Barraquer Compte MD

Co-Author(s): Jose Lamarca MD**, Juan Alvarez de Toledo MDPurpose: To test combining corneal crosslinking (CXL) with orthokeratology (OTK)in human donor eyes (HDE). Methods: Six pairs of HDEs were maintained at 20mm Hg IOP. After epithelium removal, an OTK contact lens (11.8 mm diameter and10 mm main radius) was sutured to one cornea of each pair. A standard CXL proto-col was applied simultaneously to both. Pre- and postoperative IOP, pachymetry,topography, corneal hysteresis (CH), and resistance factor (CRF) were measured.Results: Average maximal K and cylinder values did not change significantly in anygroup. Average CH and CRF increased significantly in both groups, without signifi-cant differences between them. Conclusion: Corneal molding by a sutured OTKcontact lens combined with CXL does not induce permanent changes in corneal cur-vature parameters in HDE.

9:08 AMPanel discussion of previous paper

PA186 9:12 AMProspective, Randomized, Contralateral Eye Comparison of Visual Outcomes in Custom vs. Conventional (Conv) PRK With VISX S4 LaserPresenting Author: Mark D Mifflin MD**

Co-Author(s): Christopher J Kurz MD, Majid Moshirfar MDPurpose: To compare visual outcomes after custom and conventional PRK. Meth-ods: After institutional review board approval, 48 eyes of 24 patients wererandomized to custom PRK in 1 eye and conventional PRK in the fellow eye accord-ing to a standardized protocol. Results: At 6 months there was no statisticallysignificant difference between custom and conventional groups in mean uncorrectedlogMAR visual acuity (-0.02 ± 0.09 and -0.03 ± 0.08), higher-order aberrations,or contrast sensitivity. Neither group had significant haze, complications, or need forenhancement. Conclusion: Both custom and conventional PRK provide excellentvisual outcomes.

9:20 AMPanel discussion of previous paper

PA187 9:24 AMLASIK Flap Thickness Created With the Fifth Generation Femtosecond LaserPresenting Author: Mohamed A Guenena MD*

Co-Author(s): Helga P Sandoval MD*, Kerry D Solomon MD*Purpose: To evaluate accuracy and reproducibility of LASIK flap thickness createdby a fifth-generation femtosecond laser (iFS Advanced Femtosecond Laser). Meth-ods: In a prospective, unmasked study, a total of 24 eyes underwent LASIK. Flapthickness was intended to a depth of 100 and 110 microns. Measurements usingintraoperative pachymetry and postoperative anterior segment OCT were taken at 3months. Measurements were compared to intended thickness. Results: Pachyme-try measurements were 109 μm (± 9.6), 119 μm (± 11.5) for an intendedthickness of 100 μm and 110 μm, respectively, while OCT measurements were 117μm (± 11.2) and 123 μm (± 6.5). Conclusion: High consistency and reproduc-ibility of flap thickness were seen when the fifth-generation laser system was used tocreate the flaps.

9:32 AMPanel discussion of previous paper

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PA188 9:36 AMLong-term Results for the Treatment of Myopia-Presbyopia With the AMO VISX Excimer Laser SystemPresenting Author: Gustavo E Tamayo MD*

Co-Author(s): Claudia Castell MD, Pilar Vargas MD**Purpose: To demonstrate safety and efficacy in treatment of myopia in presbyopicpatients with CustomVue ablation and presbyopia multifocal shape to preserve thenear vision. Material: Sixty eyes (53 years) with myopia and presbyopia underwenttreatment with an AMO Visx Laser with CustomVue for myopia and special multifocalablation (T shape: near periphery). Mean follow-up: 35 months. UCVA, BCVA, andcontrast sensitivity VA (CSVA) for distance and wavefront changes were recorded.Results: One hundred percent had UCVA 20/30; 75% had 20/20; 100% hadBCVA of 20/20, and 30% had 20/15. CSVA returned to normal in 4 months. Noloss of BCVA; enhancement rate was 12%. Patient satisfaction was very high. Con-clusion: The AMO Visx T shape ablation added to a CustomVue myopia treatmentto create a multifocal cornea in eyes with myopia and presbyopia is safe, effective,and very satisfying for patients.

9:44 AMPanel discussion of previous paper

Retina, Vitreous

Sunday, Oct. 254:30 - 5:30 PM

SOUTH, Room 238

PA133 4:30 PMAnatomical and Visual Acuity Results of Macular Surgery With 25-Gauge VitrectomyPresenting Author: Gopal Pillai

Purpose: To evaluate the anatomical and visual acuity results of macular surgerywith 25-gauge vitrectomy. Methods: Retrospective analysis of OCT patterns, cen-tral macular thickness, and visual acuity was evaluated preoperatively and at 1 week,1 month, and 6 months postoperatively. The data were statistically compared.Results: There were macular holes (n = 40), epiretinal membrane (ERM) (n = 25),and vitreomacular traction (VMT) (n = 15). In 80% of cases, visual acuity improve-ments of 1 line, 2 lines, and 3 lines were seen in 80%, 50%, and 40%,respectively. OCT showed significant reduction of macular thickness in the ERM andVMT group (P < .05) Macular hole closure rate was 82.5%. Conclusion: Opti-mally performed 25-gauge macular surgery had good visual and anatomical results.OCT helped significantly in patient selection and surgical decision making.

4:38 PMPanel discussion of previous paper

PA134 4:42 PMCorrelation Between Fundus Fluorescein Angiography and Optical Coherence Tomography in Diabetic Macular IschemiaPresenting Author: Mahesh Gopalakrishnan MS FRCS Ed

Co-Author(s): Gopal PillaiPurpose: To evaluate the patterns of macular edema in cases of diabetic macularischemia and to correlate the patterns with the severity of ischemia. Methods: Thefundus fluorescein angiograms and OCTs done between January 2005 and Decem-ber 2008 were retrospectively analyzed, and cases of diabetic macular ischemiawere selected for the study. Results: Forty-four eyes of 26 patients were studied.Ischemia was moderate in 60.2% and severe in 39.8%. The OCT patterns werespongy in 12 (27.3%), cystoid in 10 (22.7%), normal in 3 (6.8%), and foveal atro-

phy in 19 (41.2%). Moderate ischemia showed edematous patterns on OCT (72%),and severe ischemia showed foveal thinning on OCT (75%) (P < .05). Conclu-sion: As the ischemia progresses, the foveal OCT pattern shifts from edematous tofoveal atrophy.

4:50 PMPanel discussion of previous paper

PA135 4:54 PMAssociation Analysis of LOC387715 Gene Polymorphism in Brazilian Population With AMDPresenting Author: Marcio B Nehemy MD

Co-Author(s): Luciana N Almeida MD**, Rachel Melilo-Carolino MBBS**, Diogo Sperandio MBBS FRCOphth**, Luis A Demarco MD**Purpose: To investigate the association between LOC387715 gene and AMD in acohort from Brazil. Methods: We examined 76 affected individuals and 70 sex-agematched controls. Genotyping for the LOC387715 (rs10490924) single nucleotidepolymorphism (SNP) was performed. Results: Mean age was 74.4 (± 8.9) years.A prevalence of 72.3% was observed for A69S variant among AMD cases com-pared with 38.5% among controls (P < .05). Subjects with one copy of this varianthad a 4.17-fold (P < .0001) (95% CI, 2.07–8.36) increased risk of AMD. Con-clusion: The present data provide a strong association of LOC387715polymorphism among Brazilian AMD patients.

5:02 PMPanel discussion of previous paper

PA136 5:06 PMWide Field Angiography and Documentation of Peripheral Perfusion and/or Ischemia in Patients With Wet AMDPresenting Author: Mike Bennett**

Co-Author(s): Karl E Waite MD**, Clifton S Otto MD**, Annie Hiller**Purpose: To utilize wide-field retinal angiography to assess the peripheral vascularperfusion and relative ischemia in patients with active wet compared to dry AMD.Methods: Fluorescein angiography, OCT, and macular autofluorescence wereobtained on 128 eyes. Results: Peripheral nonperfusion and resultant late angio-graphic leakage was found in patients with active AMD. Conclusion: Peripheralperfusion or lack thereof may be a key marker for the relative AMD disease state.Measuring peripheral angiographic perfusion and understanding this potential sourceof VEGF might be important in ongoing AMD therapy.

5:14 PMPanel discussion of previous paper

PA137 5:18 PMEvaluation of a System for Automatic Detection of Neovascular AMD Using Optical Coherence Tomography (OCT) ImagesPresenting Author: Rodrigo Abreu MD*

Co-Author(s): Pedro Serrano MD PhD**, Cayetano Guerra Artal PhD**, Luis Anton Canalis**, Pedro Domingo Abreu Reyes MD**Purpose: To evaluate sensitivity and specificity of a computer-aided diagnosis(CAD) for automated screening of neovascular AMD using macular OCT images.Method: Retrospective cross-sectional study of 264 OCT images (155 fromhealthy subjects and 109 from AMD patients), randomly and blindly assessed by theCAD and one retinal specialist. Results: CAD software showed a sensibility of81.7% and a specificity of 77.4%. Positive predictive value was 71.8% and nega-tive predictive value was 88.7%. Conclusion: Automated detection of neovascularAMD OCT images could be a valuable tool for complementing , as a second reader,neovascular AMD screening.

5:26 PMPanel discussion of previous paper

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Monday, Oct. 263:15 - 4:15 PM

SOUTH, Room 238

PA180 3:15 PMMultiplex Nested Polymerase Chain Reaction for Bacterial Endophthalmitis DiagnosisPresenting Author: Gustavo Barreto De Melo MD**

Co-Author(s): Paulo José Martins Bispo MS**, Maria Cecíia Zorat-Yu PhD**, Monica Pinanez MD**, Ana Hofling-Lima MD MBAPurpose: To assess the accuracy of an “in house” multiplex nested polymerasechain reaction (PCR) protocol for detection and gram differentiation of bacterialpathogens involved in infectious endophthalmitis. Methods: Eleven vitreous and 10aqueous samples were evaluated by Gram staining, culture and multiplex nestedPCR. Results: Gram staining and culture were positive in 44% and 47%, respec-tively. Multiplex nested PCR was positive in 100% of the aqueous and vitreoussamples. Gram classification could be achieved in 88% of these cases. Conclu-sion: The presented multiplex nested PCR protocol showed to be highly sensitive inthe identification of bacteria in cases of endophthalmitis.

3:23 PMPanel discussion of previous paper

PA181 3:27 PMPediatric Retinal Detachments in Costa RicaPresenting Author: Erick Hernandez MD**

Co-Author(s): Joaquin Martinez MD, Lihteh Wu MDPurpose: To describe the clinical features and surgical outcomes of retinal detach-ments (RD) in the pediatric population. Methods: Retrospective study of patientswith RD from a tertiary referral center between 1995 and 2009. Results: A total of134 patients were included. The average age was 7.3 years; 71% were boys. Themost common type of RD was rhegmatogenous (51%). The main causes weretrauma, 18%; Coats disease, 12%; and toxocariasis, 8%. Retinal reattachment wasachieved in 63%, with an average of 1.7 surgeries; 19.4% were considered nonsur-gical. The most commonly performed procedure was scleral buckling (49%).Conclusion: Rhegmatogenous RD is the most common type of RD in the CostaRican pediatric population. Trauma is the main cause.

3:35 PMPanel discussion of previous paper

PA182 3:39 PMIntravitreal Anti-VEGF Treatment for Radiation Retinopathy After Plaque RadiotherapyPresenting Author: Teodoro J Evans MD

Co-Author(s): Filiberto Altomare MD**, E Rand Simpson MD, Hatem A Krema MBBS**, David R Chow MD*, Alan R Berger MD*, Louis Robert Giavedoni MD**, David T Wong MD*Purpose: To evaluate the effect of anti-VEGF treatment on patients with radiationretinopathy. Methods: Retrospective case series of seven consecutive patients.BCVA, central foveal thickness (CFT), and fluorescein angiography findings were pri-mary outcomes. Results: Patients received an average of 4 injections ofbevacizumab during a mean follow-up of 9.5 months. Mean BCVA was 20/160,20/100, and 20/80 at baseline and 3 and 6 months, respectively. Five eyes hadmacular edema with CFT of 413 μm, 360 μm, and 347 μm at baseline and 3 and 6months. Four eyes presented retinal ischemia and 2 with vasculitis showing FAimprovement. Conclusion: Intravitreal anti-VEGF therapy seems to be effective intreating complications related to radiation retinopathy.

3:47 PMPanel discussion of previous paper

PA183 3:51 PMFlow Chart for Fluorescein Angiography AnalysisPresenting Author: Eduardo P Mayorga MD

Co-Author(s): Ana Gabriela Palis MDPurpose: To present a flow chart designed to simplify the analysis of fluoresceinangiograms. Methods: Authors describe a flow chart based on 8 key questions,which must be answered through the analysis of an angiogram in order to progres-sively arrive at a diagnosis. Results: The flow chart and the questions makesystematic analysis of angiograms easier, allowing users to arrive at a more accurateangiographic diagnosis. Conclusion: The flow chart and key questions simplifyangiographic analysis, helping to systematically obtain an accurate angiographicdiagnosis, especially to those initiating in its analysis. It is also a simple educationaltool for those teaching interpretation of this ancillary test.

3:59 PMPanel discussion of previous paper

PA184 4:03 PMEndophthalmitis Rate After Intravitreal Injections With or Without DrapePresenting Author: Vasiliki Kounali**

Co-Author(s): Theoni D Panagiotoglou MD**, Paraskevi Drakou MD**, Kyriaki Raptaki**, George D Pappas MD**Purpose: To evaluate the necessity of using a drape during intravitreal injections.Methods: One thousand patients were randomly assigned in 2 groups: Group 1with and Group 2 without drape. The rest of the procedure followed the AmericanAcademy of Ophthalmology guidelines for intravitreal injections. Results: Onepatient in the drape group developed endophthalmitis. Coagulase negative Staphylo-coccus was isolated. She was treated successfully with vitrectomy, intravitrealantibiotics, and silicone oil injection. One patient developed sterile endophthalmitisand 2 more patients developed severe uveitis. Conclusion: The use of a drapemay not be required for intravitreal injections. The participation of greater number ofpatients (10,000) is necessary to infer safer results.

4:11 PMPanel discussion of previous paper

Tuesday, Oct. 2710:15 - 11:15 AMSOUTH, Room 236

PA189 10:15 AMEstudio Prospectivo Randomizado de Tincion de la Membrana Limitante Interna con Verde de Indocianina vs. Triamcinolona en la Cirugia de Agujero MacularPresenting Author: Gonzalo Sepulveda**

Co-Author(s): Cristian G Carpentier MD**, Luis H Filsecker MD, Juan I Verda-guer Diaz MD**Objetivos: Evaluar el éxito anatómico y funcional de la cirugía de agujero macularcon extracción de la membrana limitante interna (MLI) al utilizar una técnica de tin-ción y una técnica de marcación. Material y Métodos: Estudio clínicoprospectivo, randomizado. Se realizó vitrectomía pars plana con peeling de la MLIcon Indocianina Verde (ICG) en 20 ojos y Triamcinolona (T) en 20 ojos, según ran-domización. Resultados: No hubo diferencias entre la tasa de cierre del agujeromacular (ICG 100%, T 94.74%, P > .05), en la agudeza visual final (ICG 0.45 ±.28 LogMAR, T 0.46 ± .48 LogMAR, P > .05), ni en las incidencias de complica-ciones entre ambos grupos (P > .05). Conclusión: Ambas técnicas tienenresultados anatómicos y funcionales similares.

10:23 AMPanel discussion of previous paper

Page 16: 2009 Final Program PAAO Papers

* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Up-to-date information is available in the Online Program on the Academy's Web site: www.aao.org.

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PA190 10:27 AMTwo-Port Pars Plana Vitrectomy Using Indirect OphthalmoscopyPresenting Author: silvio arellano MD**

Co-Author(s): Monica C Mendoza MD**, Felipe Torres MD**, Julio Blanco MD**, Johnny Zumaeta MD**, Ivan Cornejo MD**Purpose: To describe our experience performing 2-port pars plana vitrectomyusing indirect ophthalmoscopy as unique light source. Methods: Case series. Inorder to obtain data, we reviewed the clinical histories and the operating room reportbook. Results: We performed 20 surgeries (11 males and 9 females). The ageaverage was 63.15 years. The average follow-up time was 147.50 days. The rea-sons for performing vitrectomy were 35%, proliferative diabetic retinopathy; 30%,vitreous opacities; 15%, retinal detachment; and 20%, other. The average operativetime was 116 minutes. The visual acuity after surgery improved in 60%, remainedunchanged in 30%, and worsened in 10%. Conclusion: It is possible to perform2-port pars plana vitrectomy using indirect ophthalmoscopy.

10:35 AMPanel discussion of previous paper

PA191 10:39 AMCombined Indocyanine Green-Mediated Photothrombosis (IMP) with High-Dose Intravitreal Bevacizumab in Isolated Choroidal MetastasisPresenting Author: Juan V Espinoza-Garcia MD

Co-Author(s): Andr Francisco Lasave MD, J Fernando Arevalo MD FACSPurpose: To report indocyanine greenñmediated photothrombosis (IMP) combinedwith high-dose intravitreal bevacizumab (IVTB) for the management of choroidalmetastasis (CM) from breast cancer. Methods: Interventional case report of 3 con-secutive eyes (2 patients). Patients were submitted to 1 session of IMP combinedwith high-dose (4 mg/0.16 ml) IVTB. Results: Two female patients (3 eyes), 47and 70 years old, respectively, were managed with unsuccessful chemotherapybefore presentation. Ophthalmic evaluation demonstrated complete tumor resolution,reduction of subretinal fluid, and improvement in visual acuity in all eyes at 3 to 5weeks. Conclusion: IMP combined with high-dose IVTB may be an adjuvant ther-apy to systemic chemotherapy for the management of isolated CM.

10:47 AMPanel discussion of previous paper

PA192 10:51 AMVitrectomy Without Internal Tamponade in Primary Retinal Detachment With Mild to Moderate Proliferative Vitreo-RetinopathyPresenting Author: Mohamed A Elmalt MD**

Purpose: To achieve permanent reattachment by scleral buckling (SB) of all retinalbreaks and release of all vitreous traction without internal tamponading. Method: Allpatients (25 eyes) had complete triamcinolone assisted vitrectomy, fluid -airexchange, precise localization of breaks with no traction, placement of appropriateSB, air-fluid exchange and tightening of SB (firm globe), and endolaser to buckledbreaks. Results: Retinal reattachment without reoperations for at least 6 months(duration of follow-up ) with success rate 96%. Visual outcome depended on preop-erative visual acuity, macula status, and duration of macular detachment.Conclusion: Vitrectomy plus SB achieved time-dependant successful results with-out need for vitreous substitutes and their complications.

10:59 AMPanel discussion of previous paper