PL3-1

　　Uveitis and Intraocular inflammation in Asia

　　Shigeaki OHNO

　　Department of Ophthalmology and Visual Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan

　　Uveitis and intraocular inflammation(II) sometimes run a chronic course with recurrence. Visual prognosis is poor if correct diagnosis and proper management are not done. It is well known that the etiology and cause differ from one population to another. Therefore, it is important for us Asian to know what are the major uveitis entities in Asian populations.
Among the infectious II, tuberculosis and syphilis have to be always differentiated, although the frequency is not very high. Viral II includes anterior segment II as well as posterior segment II due to HSV and VZV. Visual prognosis of acute retinal necrosis syndrome is poor, and early management is mandatory. Other infectious II includes HTLV-I associated uveitis, Lyme disease and ocular toxocariasis.

　　Noninfectious II includes sarcoidosis, Behcet’s disease and Vogt-Koyanagi-Harada’s disease. Fuchs’iridocyclitis and Posner-Schlossman’s syndrome are also seen in Asian population.
New medical and surgical treatment of II has been developed as a result of recent development in molecular immunology. In this lecture, clinical characteristics and management of various uveitis and II frequently seen in Asia will be presented. 

　　PL3-2

　　Ocular Immunopathology and Molecular Pathology of von Hippel-Lindau (VHL) Disease

　　Chi-Chao Chan, M.D., Xiaoling Liang, M.D.,* Defen Shen, Ph.D., Christine M. Bojanowski, B.S., Emily Y. Chew, M.D., Zhengping Zhuang, M.D., Ph.D.`

　　National Eye Institute and `National Institute of Neurological Disorders and Strokes, National Institutes of Health, Bethesda, MD, USA, and *Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
 
　　Von Hippel-Lindau (Vhl) Disease Is An Autosomal, Dominant Inherited Cancer Syndrome That Occurs In 1/36,000 Live Births Per Year.  Of All Vhl Patients, 49-85% Develop Retinal Hemangioblastomas Making This Ocular Sign The Most Common Presentation Of The Disease.  Vhl-Associated Tumors Have Revealed An Allelic Deletion Within The Vhl Gene Locus Termed “Loss Of Hetrozygosity (Loh)”.  Loh Within The Vhl Gene Is Detected In The Stromal Cells Of Ocular Hemangioblastomas. Increases Of Vascular Endothelial Growth Factor (Vegf), Hypoxia Induced Factor (Hif), And Ubiquitin Are Found In Ocular Hemangioblastomas.  Tumorlet Cells, Which Are Composed Of Poorly Differentiated Small Cells With Prominent Dark Nuclei And Little Cytoplasm, As Well As Several Stem Cell Markers, Such As Erythropoietin (Epo), Epo Receptor (Epor), And Cd133 Are Found In Ocular Vhl Lesions.  In Addition, Cxcr4, A Cxc Chemokine Receptor Regulated By Hif And Required For Normal Embryonic Development Of The Neural, Hematopoietic, And Cardiovascular Systems, Is Present In Retinal Vhl Hemangioblastomas.  These Findings Imply That Vhl Cells With Loh Of The Tumor Suppressor Gene Most Likely Originate From A Hematopoietic/Vascular Lineage.  Targeting These Proteins And Other Ischemic Factors, Not Only Vegf, May Be A Potential Therapeutic Approach For Retinal And Optic Nerve Hemangioblastomas Associated With Vhl.

　　PL3-3

　　Intravitreal Bevacizumab versus Triamcinolone Acetonide for Exudative Age-Related Macular Degeneration

　　Jost B. Jonas, MD

　　Department of Ophthalmology, Faculty of Clinical Medicine Mannheim of the University Heidelberg, Germany

　　Objective. To compare an intravitreal high-dose injection of triamcinolone acetonide versus an intravitreal injection of bevacizumab for treatment of progressive exudative age-related macular degeneration (AMD).

　　Design. Comparative non-randomized retrospective clinical
interventional study

　　Participants. The study included 305 patients with progressive AMD, divided into a bevacizumab group of 36 patients (1.5 mg bevacizumab) and a triamcinolone group of 269 patients (about 20 mg triamcinolone). All patients were consecutively included, in the first phase of the study for triamcinolone, and in the second phase of the study for bevacizumab. Mean follow-up was 8.5 ± 6.8 months (2-35.7 months).

　　Methods. Intravitreal injection of triamcinolone (about 20 mg) or bevacizumab (1.5 mg).

　　Main Outcome Measure. Visual acuity, intraocular pressure.

　　Results. In the bevacizumab group, best visual acuity increased significantly (P<0.001) by 3.2 ± 3.4 Snellen lines or -0.31 ± 0.33 logMAR, with 25 (69%) eyes and 21 (58%) eyes, respectively, improving by at least 2 Snellen lines and 3 lines, respectively. Increase in visual acuity was significant for the measurements taken at two months after the injection (P<0.001). In the triamcinolone group, best visual acuity increased significantly (P<0.001) by 0.87 ± 2.88 Snellen lines or–0.09 ± 0.31 logMAR, with 95 (35%) eyes and 59 (22%) eyes, respectively, improving by at least 2 Snellen lines and 3 lines, respectively. The visual acuity change was not statistically significant for any specific follow-up examination within the first 3 months. Comparing the bevacizumab group with the triamcinolone group, the maximal increase in visual acuity was significantly (P<0.001) higher in the bevacizumab group. The same held true for the comparison of the visual acuity change at 2 months after the injection (P<0.001).

　　Correspondingly, the percentage of patients with an visual acuity improvement by at least 2 Snellen lines and 3 lines, respectively, was significantly (P<0.001) higher in the bevacizumab group. Intraocular pressure increased significantly (p<0.001) in the triamcinolone group, and did not change significantly (P=0.47) in the bevacizumab group.

　　Conclusions. In exudative age-related macular degeneration, intravitreal bevacizumab (1.5mg) compared with intravitreal triamcinolone acetonide (about 20mg) results in a higher improvement of visual acuity and does not markedly influence intraocular pressure within 2 months after injection.

　　PL3-4

　　Update in the Genomic Mapping for Eye Disease Genes

　　Chi Pui Pang

　　Chinese University of Hong Kong,Hong Kong Eye Hospital

　　PL3-5

　　Assessing the Economic and Health Burden of Eye Disease
Leon B. Ellwein, Ph.D.  National Eye Institute， Bethesda, Maryland, USA

　　As noted recently by the 59th World Health Assembly, visual impairment and blindness place a tremendous burden on society.  Direct medical costs (personal and government) associated with treating eye disease throughout the world are large, even though visual impairment is vastly under-treated in many countries.  Equally consequential are the indirect costs of visual impairment, primarily lost productivity and earnings among both the impaired subject and family caregivers. In the U.S.A., the annual direct costs of eye care are estimated to be $48.7 billion, along with indirect costs of $18.9 billion.

　　The impact of eye disease extends beyond financial cost to health related quality of life.  Eye disease results in loss of healthy life because of the pain and suffering associated with visual impairment/blindness. The WHO uses disability adjusted life years (DALYs) as a metric for estimating the years of healthy life lost due to a condition or disease. Globally, it is estimated that visual impairment and blindness result in an annual loss of 46,121,000 DALYs, which in economic terms translates into a loss equivalent to $5.5 trillion per year.

　　PL3-6

　　Paul Lee

　　Duke University,USA

　　PL3-7

　　中国眼科的发展和国际化之路

　　赵家良

　　中国协和医科大学  中国医学科学院北京协和医院  眼科研究中心

　　起源于3500年前中医眼科学的发展，17～19世纪西方眼科学通过各种途径的传入，19世纪下半叶之后医学院校在中国建立，汇集成为今天中国的眼科学。但是中国现代眼科学的真正发展仅仅经历了半个多世纪,特别是近20年来，中国眼科发展取得了惊人的成就。国家大力支持眼科事业发展，中国大陆的眼科机构已达4000多个，眼科医师的总数已达22 000多名；防盲治盲取得巨大进展，盲患病率明显下降；眼科学术活动空前活跃，学术会议的规模不断扩大；眼科杂志和眼科书籍大量出版；现代新疗法、新技术不断应用；基础研究发展迅速，学术水平日益提高。中国眼科界认识到，中国眼科所取得的成就与国际眼科界的支持是分不开的，中国眼科只有与世界眼科发展结合在一起，才能获得快速的发展。为此中国眼科界做了不少努力。在刚刚实行改革开放政策时,就派出资深的眼科学家到美国等地考察, 了解世界眼科发展的趋势。大批眼科医生参加国际眼科学术会议。邀请国外专家访问,一些国际会议在中国召开，积极开展学术交流。而且加入了眼科学会联盟和亚太眼科学会。目前中华眼科学会正在积极筹办一些国际眼科学术会议。我们有理由相信，与国际眼科界共同努力下，中国的眼科事业将会以更快的速度发展。

　　声明:本站独家报道，转载须标明来源“中华眼科在线”