MEACO: ELZA goes to Jordan

The Middle East Africa Council of Ophthalmology (MEACO) Congress is one of the highlights of our congress calendar each year. It attracts some of the biggest names in ophthalmology, and the standard of the presentations and the quality of debate is as good as any conference in our specialty.

I was honoured to be invited to give a series of talks during this year’s MEACO congress, held in the Hilton Dead Sea & Spa Hotel in Amman, Jordan.

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Individualized CXL for thin corneas

My first task was to participate in the MEACO “Experts’ Top Tips” session, where I gave a presentation on CXL and Thin Corneas, reviewed the history of performing CXL in thin corneas, followed by the work performed by our research group at the University of Zurich that examined the essential components of the cross-linking photochemical reaction: chromophore availability, UV light intensity, exposure time and the biological response, how we combined each of these factors to a model, and how we’re using that model, combined with measurements of corneal thickness, to tailor cross-linking protocols to each person’s individual corneal thickness – and how this can be used to treat thin corneas, without resorting to swelling the cornea with hypo-osmolar riboflavin or other approaches like contact lens-assisted cross-linking.

PACK-CXL

My next talk was in the infectious keratitis session, where I spoke about using CXL to treat infectious keratitis (PACK-CXL). During cross-linking, an overwhelming amount of Reactive Oxygen Species (ROS) are created when UV light photo-activates the riboflavin that has been applied to the cornea. This not only cross-links the collagen molecules in the stroma, strengthening the cornea and increasing its resistance to ectasia, but also catabolic enzymes, such as those produced by inflammatory processes – or invading pathogens. But the ROS serve a more important purpose in PACK-CXL: they damage the cell walls of invading pathogens and intercalate with their DNA. CXL – whether it’s used to treat ectasia or infection renders the cornea sterile. And so I was happy to review what we currently know about PACK-CXL, from the basic science, to the latest updates from large-scale clinical evaluations of PACK-CXL for the treatment of keratitis. CXL is now possible with portable, rechargeable, slit lamp-mounted CXL devices – and this represents a phase shift from current clinical practice. CXL is currently performed in sterile, expensive operating rooms. It doesn’t have to be. It can be performed anywhere there’s a slit lamp. And given slit lamps are ubiquitous – wherever there’s an eye doctor, there’s a slit lamp, this dramatically opens up the possibility of treating infectious keratitis with CXL to most parts of the world – not large hospitals in major population centres. PACK-CXL has been used to successfully resolve infectious keratitis without even the use of antimicrobial drugs – with a single treatment. This could prove to be increasingly valuable as antimicrobial drug resistance rises – and in parts of the world where access to these drugs is limited.

On Friday, I was involved in the MEACO “Controversies in CXL” session, where I spoke about “Epi-off CXL”. For me, there is no doubt in my mind that for now epi-off remains the gold standard of cross-linking: for CXL to work, riboflavin has to be in the corneal stroma, and the epithelium has to be removed for the riboflavin to get there. Attempts to force the riboflavin through by chemical or electrochemical means still result in poorer riboflavin penetration into the stroma, less effective cross-linking, and an increased probability of keratoconus progressing again later, and I remain unconvinced otherwise by published data to date – so in this talk, I reviewed the evidence base behind my conclusions. However, this might change in the near future, because more sophisticated epi-on protocols may help increase the efficacy of epi-on.

CXL at the Slit Lamp

I later spoke about cross-linking at the slit lamp – again, reviewing the reasons why CXL does not need a sterile OR to be performed as it sterilises the cornea, and the cost and availability advantages this approach brings – in particular, bringing effective, potentially “one-shot”, antimicrobial drug-free infectious keratitis treatment to disperate rural parts of developing countries where such an intervention can not only help many, but is desperately needed too.

Is keratoconus really rare?

Keratoconus is not “really rare”. People just thought it was, thanks to a landmark study published in 1986 in Olmstead County, Minnesota, that estimated the prevalence as being 1:2000. The 1980s might have been famous for big hair and the best albums Depeche Mode ever released, but it wasn’t famous for having sensitive corneal diagnostic instruments. Today’s corneal tomographers and topographers are light years ahead in their ability to map the surface and shape of the cornea, and diagnose corneal ectasias like keratoconus. The impact this has had is obvious. But the work of a charity I am involved with, the Light for Sight Foundation, is helping reveal the true global prevalence of keratoconus, and we are seeing large variations in keratoconus prevalence, and it will be interesting to investigate the factors behind this, and whether they are environmental, genetic, or a bit of both. One thing is clear: keratoconus is not a “really rare” disease.

Instructional Course

I was also honoured to be asked to lead an Instructional Course at MEACO: the Light for Sight course on CXL: from detection to treatment. This is an important topic: when and how to treat. It can be broken down into two parts: paediatric and adult keratoconus. In children, keratoconus tends to be more progressive and severe than in adult patients. The indication for cross-linking an adult with keratoconus is if progression is detected (there’s no point treating a cornea with a surgical intervention if the disease isn’t getting worse – the benefit-risk ratio isn’t favourable), but in children, the risks are much higher, pushing the benefit-risk calculation towards prompt cross-linking. Although my views on the current effectiveness of epi-on cross-linking are clear, I do believe in certain cases, epi-on CXL is an appropriate choice for CXL in certain patient groups, and I reviewed those circumstances in that session.

CXL at the Slit Lamp Wet lab

Finally, I led a MEACO 2019 CXL Wet Lab, where I was able to teach the assembly of enthusiastic ophthalmologists how to perform cross-linking, using porcine eyes and the C-Eye portable cross-linking device.

To Dr. Samir El-Mulki, Dr. Ibrahim Alnawaiseh, Dr. Mubarak Al Farran, Prof. Wisam Shihadeh and Ms. Huda Hijazi, and everybody else involved in making the MEACO 2019 conference the huge success it was, I wish to offer my sincere thanks for everything.

 

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Augeninstitut ELZA
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Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
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