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positive stains (mutant p 53) per 100 cells were identified in magnitude of 400 times. Results: Primary pterygia group has a mean level of p 53 expression 10,42, while in post injection pterygia group has a mean level of 11,11.(t test,p⫽0,87,with Confidence Interval 95% lower bound:-10,11 upper bound:8,72). Conclusion: There were no difference in p 53 expression between the two groups. ABS 50 A RANDOMIZED COMPARISON ON THE CORNEAL ENDOTHELIAL MORPHOLOGY AFTER THE USE OF 2 DIFFERENT VISCOELASTIC AGENTS DURING PHACOEMULSIFICATION SURGERY Shatriah I., Universiti Sains Malaysia, Malaysia Liza Sharmini A.T.; Zulkifli A.G. Purpose: To compare corneal endothelial morphological changes after the use of Healon 5 (sodium hyaluronate 2.3%) and Healon GV (sodium hyaluronate 1.4%) during phacoemulsification surgery, particularly at three months after the surgery. Methods: 110 patients were randomized, 55 per group, in a prospective randomized clinical trial of phacoemulsification surgery using Healon 5 or Healon GV. Three ophthalmologists performed the surgeries. The corneal endothelial cells density, average cell size, coefficient variation and hexagonality were assessed preoperatively and at three months postoperatively using a non-contact specular microscope Topcon SP2000. Analysis of the data was performed using SPSS version 10.0. Results: There was statistically significant difference between Healon 5 group and Healon GV group based on endothelial cell density (p⫽0.015) and percentage of cell loss (p⫽0.033). The cell size was noted significantly smaller in the Healon 5 group compared to the Healon GV group at three months (p⫽0.004). A similar result was also noted in terms of percentage of changes in cell size (p⫽0.033). There were no statistically significant differences in changes of coefficient variation of cell size and hexagonality in both groups at three months after the surgery. Conclusion: Minimal corneal endothelial morphological changes were noted in the Healon 5 group compared to the Healon GV group, particularly in terms of less cell loss and less alteration in cell size at three months after the surgery. Thus, indicates that Healon 5 is more effective than Healon GV in minimizing risk of corneal endothelial injury during phacoemulsification surgery. ABS 51 AMNIOTIC MEMBRANE TRANSPLANTATION FOR SYMPTOMATIC BULLOUS KERATOPATHY IN EYES WITH POOR VISUAL POTENTIAL Mohammadreza Saeedifar, Hormozgan Medical University, Iran Mohammd Javad Dehghani, Iran Purpose: To describe management of epithelial debridement and amniotic membrane transplantation for painful symptomatic bullous keratopathy who are not good candidates for a corneal transplant. Methods: This retrospective study included 9 eyes (9 patients) with symptomatic bullous keratopathy presenting with intractable pain and foreign body sensation and epiphorea and no candidates for corneal transplantation with a follow-up period of at least 24 months. Results: The mean follow-up was 30.6 months (range 25 to 42 months). A definite reduction in pain was obtained in 8 patients (89%). 33.3% of eyes had complete resolution of ocular discomfort after 1 week post operative and 66.6% after 1 month post operatively. Corneal epithelial healing was complete in all of patients. Retraction of amniotic membrane transplant occurred in 2 eyes that need surgery and 2 patients experienced a recurrence of pain associated with recurrence of epithelial disease at 15 months after surgery. Conclusion: Amniotic membrane transplantation was a safe effective as a substitute long lasting treatment for intractable pain with chronic bullous keratopathy in eyes with poor visual potential. It can be an alternative to conjunctival flap for the long-term management of patients with bullous keratopathy who are not good candidates for corneal transplantation.

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ABS 52 ANTIFUNGAL EFFECTS OF “GAMAT” (STICHOPUS CHLORONATUS) IN ASPERGILLUS KERATITIS IN RABBITS S. Bakiah, Universiti Sains Malaysia, Malaysia K. Abdul Razak; S.S. Syed Mohsin, Afifi A.B. Purpose: This study aimed to determine the inhibitory effects of sea cucumber extracts and the minimum inhibitory concentration (MIC) of these extracts against Aspergillus fumigatus. Sea cucumber (Stichopus chloronatus), known as “gamat” in Malaysia, is widely used as a traditional medicine. The antifungal effects of “gamat” in Aspergillusinduced keratitis was also assessed. Methods: Based on its inhibitory effects and MIC value, a methanolic extract of S. chloronatus was used to prepare eye ointment. Aspergillus keratitis was induced in the corneas of both eyes of 7 New Zealand White rabbits and treated randomly with “gamat” extracts and placebo. A daily clinical examination and colony count was done. Results: The largest inhibition zone (average ⫽ 18.2 mm) was observed when “gamat” was dissolved in chloroform compared to other solvents. An MIC value of 1.562 mg/ml was recorded in serial dilution of the extracts using a disc diffusion method on A. fumigatus. Six rabbits were used in the study and fungus was successfully inoculated in them. Daily clinical examination showed variable degrees of infectivity and response. Colony count at the end of 5 days treatment showed no significant difference in means (P⬎0.05). The limitations of the study and suggestions were discussed. Conclusion: Methanolic extract of “gamat” inhibited fungal growth in the in vivo study. This warrants future exploration of the antifungal effects of “gamat” in a controlled clinical trial with more refined instruments and methods. ABS 53 STUDY OF CHANGES IN CORNEAL ENDOTHELIAL CELL COUNT, CELL POLYMEGATHISM AND PLEOMORPHISM IN REGULAR SOFT CONTACT LENS WEARERS WITH CONFOCAL MICROSCOPY M-L. C. Bastion, National University of Malaysia Hospital, Malaysia R. Sunder; M. Muhaya Purpose: The effects of regular soft contact lens (SCL) usage on the corneal endothelial cell count, endothelial polymegathism and pleomorphism was studied with confocal microscopy. Methods: This cross-sectional study performed at National University of Malaysia investigated changes in the endothelium in regular SCL users using an in vivo slit-scanning microscope, ConfoScan 3, capable of fully automated analysis of the endothelium. The SCL user group (GCL) was compared with normal historical controls that had never worn contact lenses (GNCL). Results: GCL (n⫽56) comprised users of 1 to 22 years’ duration. There were 99 individuals in GNCL. Endothelial cell polymegathism but not pleomorphism was significantly increased in GCL (p⫽0.036). Changes in endothelial count in GCL were not significant in multivariate analysis between the two groups (p⫽0.066). There was significant association between age and decreased endothelial count (p⬍0.0005) and increased polymegathism (p⫽0.029) and pleomorphism (p⫽0.001). Conclusion: Long term SCL use does not affect endothelial cell number but results in changes in cell behaviour as manifest in an increase in endothelial cell polymegathism independent of age and gender. This may be due to chronic hypoxia and pressure. Increase in endothelial cell pleomorphism is more indicative of age related change. This has implications for basic science knowledge as well as in pre-operative assessment for various refractive procedures and intraocular surgery. ABS 54 TOPICAL 5-FLUOROURACIL FOR THE TREATMENT OF INTRAEPITHELIAL NEOPLASIA OF THE CONJUNCTIVA AND CORNEA Mitra Zamani, Immam Khomeini Hospital-Ahvaz University, Iran Sharifipour F., Iran Purpose: To evaluate the efficacy of topical 5-Fluorouracil (5-FU) in the treatment of conjunctival and corneal intraepithelial neoplasia .

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Methods: In a before - after clinical trial, nine patients with histologic evidence of intraepithelial neoplasia identified by tumor excision were studied . Following surgical excision topical 5-FU 2% in artificial tear was administered twice daily for one month and continued daily for another month. The presence or absence of clinically evident intraepithelial neoplasia was evaluated after treatment. Patients were also monitored for adverse reactions to topical 5-FU. Results: All patients were disease free with a mean follow up of 25.6 months ( range 7-35 month . No adverse reactions with Topical 5-FU 2% were noted. Conclusion: Topical 5-FU 2% is well tolerated and effective in the treatment of conjunctival and corneal intraepithelial neoplasia when used as adjunctive treatment to surgical excision.

ciprofloxacin, doxycycline, and chloramphenicol. Less than 70% of isolated CNS were sensitive to ceftriaxon, tetracycline, erytromicine, oxacillin, cotrimaxazole and penicillin. Conclusion: Preoperative conjunctival isolates of CNS seems to be most sensitive to vancomycin, and other aminoglycosides. So in suspected patients to endophthalmitis it is suggested to start this antibiotics as soon as possible till culture results are available. ABS 57 EFFECT OF GRAFT-RECIPIENT DISPARITY ON REFRACTIVE OUTCOMES IN KERATOCONUS Mohammad Ali Javadi, Labbafinejad Medical Center, Center for Eye Research, Iran Mehran Nikkhou, Iran; Mohammad Reza Jafarinasab, Iran Purpose: To compare the refractive results of penetrating keratoplasty (PK) in two groups of patients with keratoconus undergoing corneal grafting with different amounts of donor-recipient disparity (0.25 and 0.5 mm). Methods: As a randomized clinical trial and after performing a complete ocular examination and vitreous length measurement, 30 patients with keratoconus were randomly assigned in two groups: 15 patients underwent PK with 0.25 mm graft-recipient disparity and the other 15 patients underwent the operation with 0.5 mm disparity. One surgeon performed all the operations using a single running suture technique. Best corrected visual acuity and refractive errors were evaluated 1 year after PK and also two months after suture removal. Results: One year after PK and also 2 months after suture removal there was no statistically significant difference in BCVA between the two groups. Mean spherical and mean spherical equivalent refractive error was better in the 0.25 mm group, however this difference was not statistically significant (P ⬎ 0.05). In vitreous length range of 16.2-17.7 mm (20 patients) mean spherical equivalent refractive error was -1.6 and -3.6 D in the 0.25 mm and 0.50 mm disparity groups, respectively (P⫽ 0.03). Mean spherical error was also better in the 0.25 mm group as compared with the 0.5 mm group (-0.8 versus -2.6 D, P⫽ 0.05). Mean astigmatic refractive error was minimally different between the two groups. Conclusion: Less donor-recipient disparity (0.25 mm Vs 0.50 mm) seems to lead to better refractive outcomes in penetrating keratoplasty for eyes with keratoconus and vitreous length of 16.2-17.7 mm.

ABS 55 CORNEAL TOPOGRAPHY AND SCLERAL INDENTATION S.A. Haider, Lahore General Hospital, Pakistan Qasim Latif Chaudhry, Pakistan Purpose: To evaluate the changes in the corneal topography following scleral buckling for retinal attachment surgery Methods: Twenty three eyes of 23 patients presenting at Lahore General Hospital, Lahore-Pakistan who underwent conventional retinal attachment surgery with scleral indentation were included in this prospective study. All patients had corneal topography measured before surgery and 3 days, 1 week, 1 month, 2 months and 3 months after the surgery using Humphery Atlas Corneal Topography system with Master Vue Software. The topographic parameters statistically analyzed were corneal surface cylinder, simulated keratometry, corneal regularity measure (CIM), shape factor value, average corneal power and astigmatism index. Results: A significant change in all the topographic indices was noticed from the base line pre operative values. The changes were maximum at 3 days and 1 week and gradually returned to pre operative values in 17 patients by 2 months. In 5 patients the corneal indices stabilized to pre operative values at 3 months. Conclusion: Corneal topographic indices are altered after scleral buckling for retinal attachment surgery. The corneal surface returns back to pre operative shape in majority of the patients by 2 months. The refractive errors after conventional repair surgery may be corrected after 3 months of the surgery.

ABS 58 MORCHER INTRAOCULAR IRIS DIAPHRAGM IMPLANTATION Sui Chien Wong, Moorfields Eye Hospital, United Kingdom Niaz Islam, United Kingdom; Linda Ficker, United Kingdom Purpose: To review the clinical indications, safety and efficacy of Morcher aniridic intraocular devices. Methods: Retrospective non-comparative case note review at Moorfields Eye Hospital over past 6 years (1998-2004). Results: Sixty-six patients were identified, of which 54 (79.4%) had adequate case notes for review. Fifty-eight eyes of 54 patients had implantation of Morcher intraocular aniridic device. Mean patient age was 45.2 years. Mean follow-up time was 22.8 months. Aniridic intraocular lens (IOL) was implanted in 26 eyes (44.8%), whereas iris diaphragm capsular tension rings (CTR) were inserted in 32 eyes (55.2%), with or without an IOL. Indications for surgery were traumatic iris defect (51.7%), congenital aniridia (20.7%), congenital iris coloboma (13.8%) and surgically induced iris defect (13.8%). Morcher aniridic device implantation was performed with cataract extraction in 34 eyes (58.6%), as a secondary procedure in 12 eyes (20.7%), in an IOL exchange in 3 eyes (5.2%), and with a penetrating keratoplasty in 8 eyes (13.8%). Visual acuity improved in 74.1%. Symptoms of glare and photophobia improved in 84.5%. The main preoperative complications were posterior capsule rupture (5.2%) and zonular dehiscence (5.2%). The main postoperative complications were glaucoma (6.9%), ocular hypertension requiring treatment (8.6%) and Morcher device displacement or dislocation (8.6%). There were 2 (3.4%) patients with postoperative endophthalmitis. Phthisis occurred in 2 patients following corneal graft failure. Conclusion: Morcher aniridic devices are useful in the surgical management of iris defects. Clinicians should be aware of the risk of significant postoperative complications.

ABS 56 ANTIBIOTIC RESISTANCE PATTERNS OF OCULAR BACTERIAL FLORA. A PROSPECTIVE STUDY OF PATIENTS UNDERGOING INTRAOCULAR SURGERY Dawood Aghadoost, Matini Hospital of Eye & Ear, Kashan University of Medical Sciences, Iran Khorshidi A. Purpose: To determine the antibiotic susceptibility patterns of conjunctival bacterial flora isolated preoperatively from patients undergoing intraocular surgery. Methods: This prospective observational study carried out on 269 eyes of 269 patients scheduled for intraocular surgery over a 4 month period during March to July 2004. Conjunctival cultures were obtained on the day of surgery, on the table of operating room before application of any topical antibiotic or povidine iodine. Bacterial isolates were identified and exposed with antibiotic discs on Kirby-Bauer disc diffusion test. Results: Of 269 patients 47% were male and their mean was 66 years. Among the 269 eyes, 101 cases (37.5 %) had positive cultures. Of 101 Strains isolated, 91 (90 %) were coagulase negative staphylococci (CNS). Among CNS, more than 90% were susceptible to vancomycin, amicacin and gentamicin. Between 70% to 90% of CNS were susceptible to

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ABS 59 ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS–OCULAR/CUTANEOUS MANIFESTATIONS, CAUSES AND MANAGEMENT IN TAIWAN Yi-Sheng Chang, National Cheng Kung University, Taiwan Fu-Chin Huang, Taiwan; Sung-Huei Tseng, Taiwan Purpose: To investigate the clinical features of the disease spectrum of Erythema Multiforme (EM)/Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrolysis (TEN) in Taiwan. Methods: For all patients hospitalized at National Cheng Kung University Hospital in Taiwan between 1988 and 2004 with a diagnosis of EM, SJS, or TEN, their demographic features, medication histories, ocular/ mucocutaneous manifestations, treatments, recurrences, and sequelae were obtained by medical record review. Results: A total of 207 patients between 2 months and 95 years old were hospitalized with 213 episodes/attacks of EM, SJS, or TEN. Medications were the most common cause of any condition; for SJS, carbamazepine was the most common causative agent and for EM or TEN, allopurinol was the most common cause. In 128 of the 213 attacks (60.1%; 126 patients), ocular manifestations were documented. Ocular findings were seen more often in those with SJS (81.3%) or TEN (66.7%) compared to those with EM (22.7%). The most frequent treatments for ocular manifestations were topical steroids, topical antibiotics, and lubricants. Overall, 24 (18.8%) of 128 attacks in 126 patients with acute ocular manifestations were followed by ocular sequelae, mostly dry eye. Five (2.4%) of the 207 patients sustained a total of 6 recurrent attacks, in 3 cases due to the same medication. Conclusion: Ocular manifestations and late sequelae of EM, SJS, and TEN occur in a high proportion of hospitalized patients in Taiwan. The most frequent causes of these conditions were carbamazepine and allopurinol. A careful medication/herbal remedy history should be obtained. Ophthalmic evaluation and management are mandatory. ABS 60 DEHYDRATED FORM OF 18 KDA BASIC FIBROBLAST GROWTH FACTOR-POLYETHYLENIMINE COMPLEX IS AN ACCURATE METHOD FOR GENE TRANSFER TO THE CORNEA Chien-Neng Kuo, Chang-Gung Memorial Hospital, Taiwan Pei-Chang Wu, Taiwan; Hsi-Kung Kuo, Taiwan Purpose: We describe a novel method of nonviral gene transfer into the corneal using a dehydrated form of a 18 kDa basic fibroblast growth factor (bFGF)-polyethylenimine (PEI) complex to induce angiogenesis. Methods: Corneal neovascularization was evaluated in 24 pairs of eyes of Sprague-Dawley rats after implantation of a dehydrated form of PEI containing 1 ?g green fluorescent protein (GFP; control group), or 10 ?g, 1 ?g, or 0.1 ?g of 18 kDa bFGF plasmid DNA introduced by spin vacuum at ambient temperature. Neovascularization was observed and quantified from day 1 to day 45. 18 kDa bFGF protein expression was analyzed by western blot and immunohistochemistry. Results: Limbal vessels began to sprout on day 3 in the18 kDa bFGF groups. The dehydrated form of the18 kDa bFGF-PEI complex induced dose-dependent corneal neovascularization, which reached a maximum on days 24-30 in the 10 ?g bFGF group, days 18-24 in the 1 ?g bFGF group, and days 15-21 in 0.1 ?g bFGF group, and then regressed progressively. No neovascularization was observed in the GFP group. Conclusion: The dehydrated form of the 18 kDa bFGF-PEI complex can induce corneal angiogenesis dose-dependently. It is a precise method for controlling the dose, localizing the reagents, and avoiding loss of liquid during transfection into corneal tissue. ABS 61 OUTCOME OF MANAGEMENT OF MULTILAYER AMNIOTIC MEMBRANE TRANSPLANTATION WITH A LARGE PERFORATION OF CORNEA Lan Do Thuy Le, Eye Hospital, Vietnam Thang Huu Diep; Huyen Thi Thanh Do Objectives: The infection of cornea often cause ocular damage and blindness. The authors present the efficacy of multi-layer amniotic

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membrane transplantation for reconstruction of large perforation of cornea. Methods: This prospective, non-comparative study comprised 36 eyes of 36 patients who were operated on for large perforation of cornea with dimension from 5mm – 8mmm. Three or four layers of fresh amniotic membrane with dimension which is larger than the perforation of cornea 2mm were applied over a large perforation and anchored with 10-0 nylon running sutures. Some cases were combined to remove the lens and anterior vitreous. The mean follow-up was 9 ⫾ 1,8 (ranging from 3 – 12) months. Results: 94,45% total reconstruction of cornea epithelium and stroma, 5,55% failure. Acuity vision was better than before in the limbus perforation. 13 eyes after AMT were replaced by cornea grafting. Complications: 16,66% secondary glaucoma, 38,88% haemorrhage under AM, 5,55% anterior chamber prolapse, 13,88% loose suture, 2,77% recurrent ulcer of cornea, 5,55% anterior staphylome. None of the eyes endophthalmitis, detachment of retina. Conclusion: Multi-layer amniotic membrane transplantation can be performed while we are waiting donor corneal tissue. It can be effective as either permanent therapy or as a temporary measure to prevent enucleation. ABS 62 COMPREHENSIVE ALLELOTYPING OF HUMAN PTERYGIUM: RESULT OF CHROMOSOME 3, 4, 8, 9,10,13,17 Paul Chung Shien Lu, Chang Gung Memorial Hospital, Taiwan Lawrence Shih-Hsin Wu, Taiwan; Peilun Wu, Taiwan Purpose: To search for specific alterations in human pterygiae and understand the molecular events leading to the pathogenesis of human pterygiae by examination of loss of heterogenesity (LOH) in human pterygiae. Methods: Forty eight pairs of samples were collected from 48 patients from the department of ophthalmology , Chiayi ChangGung Memorial Hospital, Taiwan. For those who have bilateral pterygiae, only one eye will be used in the study. The pterygium specimens were obtained by excision. We matched pterygium tissue and corresponding peripheral blood cell (PBC) DNA samples by using the ABI PRISM Linkage Mapping Sets MD-10 (400 makers) and PCR. Data of genotypes are scored for LOH using GeneMapper (ABI) software. Results: The highest percentage of LOH was found for a locus in 4q35 (STR marker D4S426, 17%, 5 in 30 informative cases) This region was not reported in previous studies and nearby the FAT and caspase 3 tumor suppression genes. The other aberrant locus is 13q14 (STR marker D13S153, 7%, 3 in 45 informative cases) which region close to RB gene. This result should help in identifying new genes whose loss of function contributes to the development of pterygium. Conclusion: Less LOH in pterygium were found, compared with other tumor tissue. DNA repair genes polymorphism or mutation should be considered as a major genetic factor for pterygium. ABS 63 LONG TERM RESULTS OF THE SEOUL-TYPE KERATOPROSTHETIC EYES Jin Hak Lee, Seoul National University College of Medicine, Korea Mee Kum Kim, Korea; Won Ryang Wee, Korea Purpose: To investigate the long term clinical results of the 9 eyes implanted with Seoul-type Keratoprosthesis(S-KPro). Methods: The patients who were diagnosed as Stevens-Johnsons syndrome(6), chemical burn(2), or ocular cicatricial pemphigoid(1) were included in this study. All the eyes showed poor wettability on the corneal surface. Preoperative visual acuities ranged from hand motion to light perception. 4 patients have advanced glaucoma or amblyopia. The S-KPros were implanted into 4 unsighted and 5 sighted eyes under informed consent. The average follow-up time was 50.4 months. Anatomical stability, visual acuity, preservation time of visual acuity, and complications were evaluated. Results: S-KPro showed anatomical success of 78% for an average of 40.9 months. An eye which developed endophthalmitis at 7 months was eviscerated. Post-operative visual acuities ranged from 20/100 to 20/50. Mean preservation time of vision was 31.6 months. Skirt started to expose in all eyes for an average of 12.9 months. Retroprosthetic membrane

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started to develop in 6 eyes after mean 16.2 months. 4 patients who had KPro exchange after its primary maintenance of mean 35.8 months experienced retinal detachment at 2 months after exchange. Conclusion: In spite of good anatomical success and improvement of visual acuity, S-KPro showed only 31.6 months of vision preservation.

ABS 66 MITOMYCIN C CHANGES THE EXPRESSION OF INFLAMMATORY CYTOKINES OF PORCINE CORNEAL FIBROBLASTS

ABS 64 MATRIX METALLOPROTEINASE (MMP-9) ACCUMULATION IN TEAR OF PATIENTS WITH OCULAR SURFACE DISEASE AND DRY EYE SYNDROME

Purpose: To investigate the expression of inflammatory cytokines expression following mitomycin C (MMC) application in porcine corneal fibroblasts. Methods: Primary porcine corneal fibroblasts, passages 3-5, were treated with MMC at concentrations of 0.2mg/ml for 1, 2, and 5 minutes. Control corneal fibroblasts were treated with DMEM. Morphological changes were documented with phase contrast microscopy and compared at 0, 24, 48, 72 hours following treatment. The effects of mitomycin C on cell morphology and cell growth were analyzed by phase-contrast microscopy. Cell viability was studied by staining with annexin V-FITC/PI and analyzed flow cytometry. The relative expression of mRNA of interleukin-1 (IL-1), IL-8, monocyte chemoattractant protein-1 (MCP-1), and transforming growth factor-beta 1 (TGF-b1) were investigated with real-time polymerase chain reaction. Results: MMC did not cause significant corneal fibroblast death but retarded cell growth as compared to control group. The expression of IL-1, IL-8, and MCP-1 were upregulated in a treatment time dependent pattern, while the expression of TGF-b1 mRNA did not change significantly. Conclusion: MMC changed the corneal fibroblast morphology and induced upregulated IL-1, IL-8, and MCP-1 mRNA expression.

Shu-Wen Chang, Far Eastern Memorial Hospital, Taiwan San-Fang Chou, Taiwan; Yao-Horng Wang, Taiwan

Elsa L.C. Mai, Far Eastern Memorial Hospital, Taiwan Yi-Yun Chou, Taiwan; Chia-Che Chang, Taiwan Purpose: Matrix metalloproteinase (MMP-9), a gelatinase that hydrolyze type IV collagen and a potent activator of the inflammatory cytokine precursor IL-1, was found to be elevated in tears of patients with active peripheral ulcerative keratitis (PUK), infectious keratitis, Sjogren’s syndrome (SS) with severe dry eye. We are therefore interested in investigating if other types of patients with ocular surface irritation have such similar correlation. Methods: Ocular surface disease patients of different category such as Sjogren’s Syndrome (SS)/autoimmune dry eye, CL related dry eye, atopic/allergic related dry eye, Meibomian Gland Disease (MGD) related dry eye, dry eye associated with epiphora, filamentary keratitis and recurrent cornea erosion patients are recruited through our clinic. Normal subjects are recruited from workers in our hospital. Tear fluid were collected with fine tipped pastettes and then later transferred to eppendoof tube. Western blot SDS polyacrylamide gel electrophoresis and zymographic gelatinase activity profiles of the MMP protein was done. Positive MMP-9 findings are those with noticeable band on the molecular wt position of 92kDa (proenzyme) and 84kDa (active enzyme). Results: Nearly all of Sjogren’s syndrome (RA ⫹) patients have positive MMP-9 finding. All patients with filamentary keratitis and recurrent cornea erosion patients have elevated level of MMP-9. Patients with dry eye complaining of epiphora also show significant increase. Normal subjects without dry eye or ocular surface disease have minimum non-significant presentation of MMP-9 in tear. Conclusion: Other then Sjogren’s syndrome, most ocular surface diseases are also highly associated with MMP-9 gelatinase presentation in tear. Therefore we speculate that patients with ocular surface disease have a significant amount of inflammatory component and should be treated with anti-inflammatory medication.

ABS 67 ROLE OF AMNIOTIC MEMBRANE TRANSPLANTATION IN MANAGING FUSARIUM SOLANIC KERATITIS Hsin-Chiung Lin, Chang Gung Memorial Hospital, Hong Kong Y.H. Kuo, Taiwan; Su-Chin Shen, Taiwan Purpose: To describe the clinical course, management, and outcome of amniotic membrane transplantation (AMT) in the management of Fusarium solani keratitis over a five year period. Methods: Retrospective, non-comparative, interventional case series. Participants: Records of 18 patients with culture proven Fusarium solani keratitis between April 1998 and November 2003 were analyzed retrospectively. Additional criteria for inclusion were the involvement of a single surgeon and a follow-up period of more than four months. The patients were divided into two groups based on the severity of keratitis and treatment strategies. Group A (n⫽13) displayed non- severe keratitis and were treated with lamellar keratectomy and antifungal medication. Group B (n⫽5) displayed advanced keratomycosis and were treated with immediate lamellar keratectomy combined with AMT and antifungal medication. Main Outcome Measures: Healing of the ulcer with no epithelial defect and the preservation of anterior chamber integrity. Results: In group A wound healing did not interfere with the integrity of the anterior chamber. The mean re-epithelialization time was 12.67 days (range 5-21). All patients were free of major immediate postoperative complications. In Group B, AMT preserved the anterior chamber integrity in two eyes, but failed to do so in the other three eyes. Therapeutic patch grafts were required in these three cases. Conclusion: Non-severe Fusarium solani keratitis is best treated with superficial keratectomy. Timely amniotic membrane grafting combined with deep lamellar keratectomy can successfully treat deep keratomycosis, reducing drug toxicity and avoiding emergent therapeutic penetrating keratoplasty. However, AMT was effective in only 40% of cases, which involved non-suppurative Fusarium keratitis.

ABS 65 THE ROLE OF APOPTOTIC PATHWAY IN PTERYGIUM FORMATION Ying-Ting Chen, National Cheng Kung University Hospital, Taiwan Sung-Huei Tseng, Taiwan Purpose: Fas ligand expression in the eye has been shown to limit the ocular inflammation and thus associates with immune privilege. Pterygium, as a disorder of cellular proliferation on the ocular surface with relatively mild ocular inflammation, was studied with flow cytometry to explore the role of Fas ligand-mediated apoptotic protection from immunological damages. Methods: Impression cytology specimens were collected in 14 patients with primary pterygium and in14 healthy controls. Cells were processed for flow cytometry, by using monoclonal antibodies directed to Fas and Fas ligand. Fluorescence intensity of FITC was quantified and the positive rates of Fas and Fas ligand expression were calculated by antibody binding capacity unit of each specimen. Results: Fas and Fas ligand expression was found in both normal and pathologic eyes. Quantitation of fluorescence intensity of Fas ligand showed a significantly higher expression in pterygia, 9.03% ⫹ 5.12%, than in normal controls, 4.88% ⫹ 3.17% (P⫽0.037). In contrast, Fas expression showed no statistical difference between pterygium eyes, 80.90% ⫹ 11.08%, and control eyes, 87.39% ⫹ 4.16%. Conclusion: Flow cytometry with impression cytology showed an upregulation of Fas ligand expression in pterygium. This finding implies that pterygium development may be in part associated with the model that Fas ligand transfers an immune tolerance to pterygium to escape from ocular immune defensive system against neoplasm.

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TEAR DYNAMICS IN FLOPPY EYELID SYNDROME

Daniel Tzong-Shyue Liu, Mackay Memorial Hospital, Taiwan Mario A. Di Pascuale, USA; Scheffer C.G. Tseng, USA Purpose: Floppy eyelid syndrome (FES) presents nonspecific ocular surface irritation. We speculate that one contributing factor is the abnormality in tear film dynamics. OF

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Methods: We consecutively examined 16 FES patients. The tear film dynamics was evaluated by kinetic tear interference images, infrared thermometry, water evaporation rate, tear break up time and fluorescein clearance test. Results: There was a high correlation between the eye with the worse symptoms and the eyes with the more severe floppy lids (P⬍0.01), and with ocular surface evaporation rate (P⫽0.02). Kinetic analysis of tear interference images revealed that lipid spread in a vertical or mixed pattern in 18 eyes (75%) with a delayed spread time (P⫽0.0007), indicating that the majority of patients suffered from lipid tear deficiency. The ocular skin temperature and water evaporation rate were higher in FES group (P⫽0.0003 and 0.026, respectively). Nearly all FES patients showed eyelid hyper-pigmentation. The ocular surface evaporation rate in FES group was also higher than that of the normal subjects (P⬍0.0001). Multiple regression analysis showed the pattern of lipid spread being vertical had a significant influence on ocular surface evaporation rate (P⫽0.003). Conclusion: The tear film abnormality is prevalent in patients with FES, and is characterized by lipid tear deficiency, leading to rapid tear evaporation. The FES lid skin is also characterized by high temperature, high water evaporation rate and hyper-pigmentation. Studies directed to investigating the linkage of lid changes and meibomian gland dysfunction may shed new light in the pathogenesis of FES. ABS 69 OUTCOME OF VARIOUS PTERYGIUM EXCISION TECHNIQUES IN TERTIARY OPHTHALMIC CENTRE IN EAST COAST MALAYSIA Khairidzan Mohd Kamal, International Islamic University, Malaysia Fatimah Suhaila, Malaysia; Vasantha Kumar Thangasamy, Malaysia Purpose: To compare success rates of various excision techniques performed for primary and recurrent pterygium in Hospital Tengku Ampuan Afzan, Kuantan, Pahang. Methods: The outcome of 47 cases of pterygia (44 primary and 3 recurrent) that were excised with various techniques between January 2004 to September 2004 were retrospectively reviewed. Six clinical specialists and four trainees performed the surgical procedures. Outcomes were evaluated in terms of recurrences of pterygia onto the cornea. Results: The mean follow up was 3.04 months (range, 1-7 months). All pterygias were morphologically graded as intermediate or fleshy type except one. Four types of pterygium excision techniques were performed. 24 cases had bare scleras, 17 cases had conjunctival autograft transplantations, 6 cases had direct conjunctival closures and one had amniotic membrane transplantation done. Recurrence occurred in 13 eyes. 12 cases from primary pterygia group and one case from recurrent group had recurred. Recurrence rates were noted to be higher in direct conjunctival closures (4 out of 6 cases) and lowest in conjunctival autograft transplantations (2 out of 17 cases). In five cases of recurrences, subconjunctival tissue invasions were more than 1 mm but further surgical interventions were not needed at the time of this review. Conclusion: Conjunctival autografting is effective in reducing pterygium excision compared with other techniques. Interestingly, recurrence rates in direct conjunctival closure technique are higher when compared to bare sclera technique. This may be related to inadequate excision of pterygia which led to direct apposition of abnormal tissue to the cornea in the former technique. ABS 70 TRANSPLANTATION OF HUMAN CORNEAL ENDOTHELIAL CELL SHEET ON A THERMO-RESPONSIVE SURFACE Ko-Hua Chen, Taipei Veterans General Hospital, Taiwan Wen-Ming Hsu, Taiwan Purpose: To investigate the feasibility for harvesting human corneal endothelial (HCE) cell sheet with intact cell junctions via temperature modulation of thermo-responsive polymer-grafted surface. Methods: Apoly-N-isopropylacrylamide (PNIPAAm) - grafted polyethylene (PE) surface was prepared by plasma induced graft polymerization. The optimal conditions for surface modification were characterized by peroxide destruction studies; static water contact angle measurements; and functional group analyses. HCE cells from donor cornea were isolated and cultured on the PNIPAAm-graft PE surface at 37?. After reaching

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confluence, the detachment of HCE cell sheet from thermo-responsive surface was attributed to the lowering temperature effect. The viability and tight junction of detached cell sheet were assessed by Live/Dead Viability/Cytotoxicity kits and zonula occludins-1 (ZO-1) immunostaining reagents, respectively. Results: 4?10-8 mole/cm2 of generated peroxides were disclosed at 160 W, 90 s, 200 motor of Ar-plasma treatment. The graft polymerization of NIPAAm monomer onto PE surface was conducted at 100 W, 30 mins UV-light irradiation. The static water contact angles of PNIPAAmgrafted surface measured at 37 and 20? were 65° and 40°, respectively. An amide absorption band at 1650 cm-1 was detected. The expression of green fluorescence due to intracellular esterase activity indicated the detached cell sheet was viable. The intact tight junction of detached cell sheet was confirmed by the lateral distribution of ZO-1 proteins. Conclusion: The technology for harvesting HCE cell sheet via temperature modulation of thermo-responsive surface was successfully developed. ABS 71 EXPRESSION AND FUNCTION OF MUSCARINIC RECEPTORS ON HUMAN CONJUNCTIVAL EPITHELIAL CELLS Shaohui Liu, Singapore National Eye Center, Singapore Jing Li; Donald T.H. Tan; Roger W. Beuerman Purpose: Muscarinic cholinergic receptors m1-m5 are found on nonneural cells where they can participate in the regulation of numerous cell functions, including proliferation. The purpose of the present study was to determine which muscarinic receptor subtypes exist in human conjunctival epithelial cells and whether they are involved in the regulation of epithelial cell proliferation. Methods: Human conjunctival epithelial cells were isolated and grown in keratinocyte growth medium (KGM). RT-PCR, real-time PCR, immunostaining and western blot for receptors m1-m5 were carried out on cultured cells, and immunostaining for m1-m5 was also carried out on fornical conjunctival tissue. Cells at passage 1-3 were starved overnight and treated with the muscarinic receptor agonist carbachol at 50, 100, 150␮M for 24hr. Cell proliferation based on BrdU incorporation was measured by ELISA. Results: RT-PCR showed the presence of m1-m5 in cultured cells and real time PCR revealed the relative abundance of message. Immunohistochemistry and western blot confirmed the presence of m1-m5 proteins in the cultured conjunctival epithelial cells and on conjunctival epithelial tissue. BrdU incorporation into conjunctival epithelial cells showed a dose dependent effect and was increased by 1.6 times in the presence of 150␮M carbachol, compared to the cells in keratinocyte basal medium(KBM) (p⬍0.05, n⫽7). KGM, the whole growth medium increased cell proliferation by 2.7 times by comparison to that in KBM( p⬍0.05, n⫽7). Conclusion: Muscarinic receptors were broadly expressed on human conjunctival epithelial cells, and these G-protein coupled receptors contribute to the control of epithelial cell proliferation. ABS 72 AMNIOTIC MEMBRANE TRANSPLANTATION FOR PERSISTENT CORNEAL ULCERS WITH OR WITHOUT PERFORATION Chau H.T.M., National Institute of Ophthalmology, Vietnam Le N.H. Purpose: To evaluate whether single or multilayer amniotic membrane transplantation can be an effective alternative treatment for persistent corneal ulcers with or without perforation. Methods: Single and multilayer Amniotic membrane transplantation was performed in 36 eyes of 36 patients with persistent deep corneal ulcer of different causes with or without perforation or corneal dystrophy after surgery that had persisted for a mean ⫹ SD of 67.2 ⫹ 40.6 days. Results: 17 eyes were performed single layer AMT (5 eyes with and 12 eyes without perforation); 19 eyes with corneal perforation underwent multilayer AMT. The timing of starting of healing in 33 patients (91.7%) was 3.4 ⫹ 1.2 days. Corneal defects were closured completely in 12.2 ⫹ 7.6 days. Three patients failed to heal because of recurrent corneal infection or the exposure of the corneas.

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placed in position without the need of suture fixation. Best spectaclecorrected visual acuity (BSCVA), endothelial cell density, and corneal thickness were examined. Results: 7 patients underwent DLEK procedure. Average BCVA preoperative was 20/800 (range 20/80 to HM), improving to 20/50 (range 20/40 to 20/120) at last follow up. Preoperative average donor endothelial cell density was 2160 ⫹ 142.8 cells/mm2, and that at last follow up was 1711 ⫹ 661.9 cells/mm2. Preoperative average pachymetry was noted to be 801.4 ⫹ 211.3 microns, improving to 569 ⫹ 115.5 microns at last follow up. Conclusion: Initial results with the DLEK procedure indicate that it is a safe procedure, that provides a healthy donor endothelial cell count and function, with encouraging visual results.

Conclusion: Amniotic Membrane Transplantation should be considered an effective solution for speeding the healing of persistent corneal ulcers and for reconstructing superficial corneal surface. ABS 73 ALLOGENIC LIMBAL TRANSPLANTATION FOR CONJUNCTIVAL-CORNEAL INTRAEPITHELIAL NEOPLASIA (CCIN) Chih-Chiau Wu, Taipei Veterans General Hospital, Taiwan Kai-Ling Peng; Shui-Mei Lee Purpose: To evaluate the treatment effect of allogenic limbal transplantation for conjunctival-corneal intraepithelial neoplasm (CCIN). Methods: A single center prospectively enrolled 12 patients (12 eyes) with confirmed diagnosis of CCIN including 8 cases of dysplasia and 4 cases of carcinoma in situ. The cases were divided in 3 groups. Group I (6 cases) received simple excision only. Four cases received topical interferona-2b (INFa2b) treatment later due to recurrence. Group II (2 cases) received simple excision and topical INFa2b just after surgery. Group III (6 cases) received allogenic limbal transplantation and INFa2b treatment due to extensive area involved (more than 6 clock hours). Results: The mean period of follow up was 57 months (6⬃98 months). The recurrence rate of simple excision was 83.33%. The recurrence rate of simple surgery combining INFa2b was 10 %. There was no recurrence after allogenic limbal transplantation in the study. There was one case recurrent after INFa2b therapy and cured by limbal transplantation. Conclusion: Allogenic limbal transplantation is safe and effective treatment for CCIN. Extensive and intractable cases of CCIN can be cured by allogenic limbal transplantation. Limbal allograft should be tried before autograft as its acceptability and availability.

ABS 76 INTRACAMERAL INJECTION OF AMPHOTERICIN-B IN DEEP KERATOMYCOSIS WITH HYPOPYON: A RANDOMIZED CONTROLLED CLINICAL TRIAL Samar K. Basak, Disha Eye Hospital & Research Centre, India Ayan Mohanta, India; Arup Bhowmick, India Purpose: To evaluate and compare the efficacy of intracameral injection of Amphotericin-B (ICA) in addition to conventional antifungal medical therapy in smear positive deep keratomycosis with hypopyon. Methods: 45 smear-positive eyes were randomized to receive intracameral injection of Amphotericin-B (5-15?g) with conventional antifungal medication (Group-A, n⫽23) or antifungal medication alone (Group-B, n⫽22), and reviewed on day 1, 3, 7, and weekly till the ulcer healed. Results: In 78.3% cases hypopyon disappeared by day 7 in Group-A compared to 36.4% in Group-B (p⬍0.005). Ulcers heal completely in 73.9% cases in Group-A compared to 40.9% in Group-B within 6 weeks (p⬍0.05). There was no serious corneal endothelial toxicity in intracameral Amphotericin B Group. Conclusion: Intracameral injection of Amphotericin-B may be a useful adjunct to treat deep keratomycosis with hypopyon in addition to conventional antifungal medication.

ABS 74 THE RISK OF MICROBIAL CONTAMINATION OF UNIT-DOSE EYEDROPS WITHIN TWENTY-FOUR HOURS AFTER FIRST OPENING Chuan-Yi Su, Kangshan Hospital of Kaohsiung County, Taiwan Chang-Ping Lin Purpose: The purpose of this study was to evaluate the risk of microbial contamination of sterile preservative-free unit-dose ocular medications within 24 hours after the first opening. Methods: Four different unit-dose ocular medications, including cromolyn sodium (20 mg/ml), timolol (5 mg/ml), gentamycin sulfate (3 mg/ml), and betamethasone (1 mg/ml) in 1 ml containers, were tested for the risk of microbial contamination after exposure to the air. After opening, the preparations were stored in acrylic protector with or without cap, at room temperature or in a refrigerator at 4°C. Samples were collected for microbiological cultures after opening for 0, 4, 10, 14, and 24 hours from the identical container. Results: No bacterium and fungus were detected in the samples through the period of the study. The microbial air contaminations of the experimental environment were also tested. The culture results of environmental microbial air contamination were positive for both bacteria and fungi. Conclusion: Our study suggests that the unit-dose eyedrops could be repeatedly used and free from microbial air contamination up to 24 hours after the first opening.

ABS 77 BETA2-ADRENERGIC RECEPTOR POLYMORPHISM AND PRESSURE LOWERING EFFECT OF TOPICAL TIMOLOL. A PRELIMINARY FINDING Liza Sharmini A.T., Universiti Sains Malaysia, Malaysia Zilfalil B.A. Purpose: To correlate the beta-2 polymorphism with the effectiveness of topical Timolol in glaucomatous patients. Methods: Newly diagnosed primary open angle glaucoma (POAG), ocular hypertension (OCT) and normal tension glaucoma (NTG) patients were recruited. Baseline intraocular pressure, visual field and cup to disc ratio were obtained before commencement of topical Timolol as monotherapy. Similar parameter measurements were repeated at 1, 3, 6 and 12 months post treatment. Based on the percentage of IOP reductions at the end of 12 months follow up from the baseline, the IOP control was divided into good (more than or equal to 30% reduction) and poor control (less than 30% reduction). 5 cc of blood was obtained from each patient for molecular genetic analysis. DNA was extracted and multiplex PCR was performed to detect 3 single nucleotide polymorphisms (SNP) at positions 79 C/G (Gln27Glu), -47T/C (Cys19Arg) and 491C/T (Thr164Ile) of the Beta-2 receptor gene. Results: 13 eligible patients were recruited. Three (23.1%) Malay, 6 (46.2%) Chinese and 4 (30.7%) Indian patients. Eight (61.5%) were diagnosed POAG, 1 (7.7%) OHT and 4(30.8%) NTG. The mean baseline IOP was 23.58 ⫾ 8.43 mmHg and mean IOP reduction was 7.00 ⫾ 4.71mmHg. There was statistically significant correlation of the good pressure lowering effect of Timolol with SNPs at 79 C/G (p⫽0.002) and -47T/C (p⫽0.002) but there was no significant correlation at 491 C/T (p⫽0.782). Conclusion: We report the preliminary findings of our study, which showed significant correlation of the role of Beta-2 receptor polymorphisms with the pressure lowering effect of topical Timolol in glaucomatous patients.

ABS 75 CORNEAL ENDOTHELIAL TRANSPLANTATION: RESULTS OF A CLINICAL SERIES USING DEEP LAMELLAR ENDOTHELIAL KERATOPLASTY (DLEK) Rajesh Fogla, Sankara Nethralaya, India Prema Padmanabhan, India Purpose: We present the results of our clinical series of replacing posterior stroma and endothelium using the deep lamellar endothelial keratoplasty (DLEK) surgical technique in patients with corneal endothelial dysfunction. Methods: Through a 5.5mm scleral incision, a deep lamellar pocket was created across the cornea, followed by excision of 8.0mm disc of posterior lamellar corneal tissue. Same size lamellar donor disc was prepared and

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ABS 78 ARGON LASER PERIPHERAL IRIDOPLASTY FOR ACUTE PHACOMORPHIC ANGLE-CLOSURE (PHACOMORPHIC GLAUCOMA) Clement C.Y. Tham, The Chinese University of Hong Kong, Hong Kong Jimmy S.M. Lai; Agnes S.Y. Poon Purpose: To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. Methods: Ten consecutive patients with acute phacomorphic angleclosure and intraocular pressure (IOP) ⱖ40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment. The IOP at 15, 30, 60, and 120 minutes, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 hours after ALPI. Cataract extraction was subsequently performed as definitive treatment. Results: Ten patients (5 male, 5 female), with a mean age ⫾ S.D. of 73.1 ⫾ 10.3 years, were recruited. Mean duration of symptomatic attack was 128 ⫾ 232 hours. After ALPI, the mean IOP was reduced from 56.1 ⫾ 12.5 mmHg to 45.3 ⫾ 14.5 mmHg at 15 minutes, 37.6 ⫾ 7.5 mmHg at 30 minutes, 34.2 ⫾ 9.7 mmHg at 60 minutes, 25.5 ⫾ 8.7 mmHg at 120 minutes, and 13.6 ⫾ 4.2 mmHg at one day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 hours after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered. Conclusion: Immediate ALPI, replacing systemic anti-glaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure. ABS 79 EFFECTS OF VITAMIN E DEFICIENCY ON RETINAS IN RATS WITH CHRONIC GLAUCOMA Mei-Lan Ko, Hsin-Chu Hospital, Taiwan Pai-Huei Pen; Chau-Fong Chen Purpose: We investigated the effect of Vitamin E deficiency on RGCs in rats after increasing intraocular pressure at various times. Methods: Female Wistar rats were divided into two matched groups: normal diet group (ND), and Vitamin E deficient diet group (EDD). The left eyes were cauterized and then were divided into 5 sub-groups: day 1, day 3, 1-week, 3-week and 5-week subgroups. The right eyes served as normal controls. RGCs were counted on 5-week subgroups. The lipid peroxides, reduced glutathione and the activities of antioxidant enzymes in isolated retinas were detected by spectrophotometry. Results: The mean number of RGCs in EDD group with an IOP elevation for 5-week was 1,334 ⫹ 21 RGC/mm2. It is significantly lower than that in ND group 1,406 ⫹ 10 RGC/mm2) (P⬍0.05). The lipid peroxides in EDD group significantly increased on day 1 but showed no difference on 5-week, compared with ND group. Reduced glutathione increased significantly on retinas after Vitamin E deficiency and still maintained almost the same level even IOP elevation. The activities of Cu/Zn SOD, MnSOD and catalase in both groups significantly rose to peak values on 1-week; the increases had no difference between each other. Conclusion: Vitamin E deficiency deteriorated the RGC loss significantly in moderately hypertensive eyes and did increase lipid peroxidation significantly after IOP elevation at various times, but this was not through the increased express of superoxide dismutase and catalase. Therefore, it is necessary to study further about the mechanism of Vitamin E on RGC survival in glaucoma. ABS 80 TRAVOPROST/TIMOLOL FIXED COMBINATION STUDY RESULTS Da-Wen Lu, Tri-Service General Hospital, Taiwan Purpose: Three Phase III clinical trials compared the IOP-lowering efficacy and safety of travoprost 0.004%/timolol 0.5% fixed combination (TravTim) ophthalmic solution to either travoprost 0.004% or timolol

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0.5% monotherapy or to the concomitant administration of travoprost 0.004% and timolol 0.5% (Trav⫹Tim). Methods: In these studies, patients with ocular hypertension or openangle glaucoma were randomized to receive TravTim in the morning and vehicle in the evening; vehicle in the morning and travoprost 0.004% in the evening; timolol 0.5% bid; or timolol 0.5% in the morning plus travoprost 0.004% in the evening. Results: Three-month results showed that mean IOP reduction following treatment with TravTim was greater at all time points than either travoprost (up to 2.4 mmHg) or timolol (up to 3.3 mmHg) alone. The difference in IOP reduction from baseline was up to 2.4 mmHg greater for TravTim than for travoprost at 8 AM. In concomitant dosing studies, the maximal IOP reduction was 9.4 mmHg (37%) for both TravTim and Trav⫹Tim and 7.0 mmHg (27%) for bid timolol. The difference in the mean IOP reduction between TravTim and Trav⫹Tim ranged from 0.0-0.3 mmHg at the important 8 AM visits. Adverse events occurred at a low incidence in all groups. Conclusion: The fixed combination therapy reduced mean diurnal IOP more than travoprost or timolol monotherapies. Travoprost 0.004%/ timolol 0.5% fixed combination therapy was similar in IOP-lowering efficacy to concomitant travoprost and timolol. TravTim administered once-daily is safe and well-tolerated with a similar safety profile to concomitant therapy or to monotherapy with each component. ABS 81 CENTRAL CORNEAL THICKNESS MEASUREMENTS IN PRIMARY OPEN ANGLE AND NORMOTENSIVE GLAUCOMA–PRELIMINARY RESULT Yushaniza Yaacob, Hospital Kuala Lumpur, Malaysia Sharifah Intan Hoesnaliza Purpose: To compare central corneal thickness (CCT) in primary open angle glaucoma (POAG) and normotensive glaucoma (NTG) patients attending the Eye Clinic in Hospital Kuala Lumpur. Methods: 45 eyes of 25 patients were included in this cross sectional prospective study. The CCT was measured using the slit scanning Orbscan and the IOP was measured with Goldmann applanation tonometry. Results: In the POAG group the mean CCT was 625 ⫹ 36.67␮m while in the NTG group the mean CCT was 588 ⫹ 42.50 ␮m. Conclusion: Central corneal thickness is significantly thicker (p⫽0.004) in patients with POAG than in patients with NTG. ABS 82 EFFICACY AND SAFETY OF BIMATOPROST 0.03% (LUMIGAN®) IN ASIA PACIFIC CLINICAL PRACTICES Cze H. Low, Mount Elizabeth Hospital, Singapore The Asia Pacific LEED Study Group Purpose: Evaluate bimatoprost for the treatment of glaucoma and ocular hypertension (OHT) in “real-life” clinical practices throughout Malaysia, Singapore, Thailand, the Philippines and Australia. Methods: Three-month, open-label, surveillance study. Patients had a diagnosis of glaucoma or OHT and were in need of additional intraocular pressure (IOP)-lowering. Results: 1793 patients enrolled. Physicians prescribed bimatoprost as monotherapy for patients not using IOP-lowering medications (n⫽279, 16.0%), as replacement therapy (n⫽721, 41.4%), or as adjunctive therapy (n⫽741, 42.6%). After 3 months of bimatoprost therapy, the mean IOP reduction in patients not using IOP lowering medications at baseline was 8.6 mmHg (32.7%, P⬍0.0001). After 3 months of bimatoprost replacement therapy, the mean IOP reduction was 4.0 mmHg (17.2%, P⬍0.0001). Patients who added bimatoprost to their ongoing treatment regimens, the mean additional IOP reduction with bimatoprost was 5.3 mmHg (20.8%, P⬍0.0001). Patients were more likely to achieve target IOPs after 3 months of bimatoprost therapy (P⬍0.0001). At the IOP target of ⫽17 mmHg, 68% of patients achieved this target at month 3, compared with 22% of patients at baseline (P⬍0 .0001). Specifically, IOP reductions with bimatoprost monotherapy from latanoprost (n⫽211) and topical beta blocker baseline monotherapy (n⫽199) was 3.4 mm Hg (15.9%, P⬍0.0001) and 5.4 mm Hg (23.5%, P⬍0.0001), respectively. 12.9% of patients reported conjunctival hyperaemia, causing 3.7% of withdrawals.

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Purpose: To determine the prevalence rates of glaucoma in adults in a rural setting in Indonesia. Methods: A population based prevalence survey of adults 21 years or older (n⫽1089) was conducted in three rural villages in central Sumatra, Indonesia during July and August 2003. A random sample of all adults aged 21 years or more living in Sering, Pelalawan and Rantau Baru was assessed. Examinations were performed on 919 adults with a participation rate of 84.4%. Patients were assessed on angle occludability by portable slit lamp biomicroscopy and the depth of the anterior chamber at the limbus was estimated. If this was less than 25% of the corneal thickness, gonioscopy was performed. Pupillary dilation was not performed when the angle was found to be occludable. The pupils of all other subjects were dilated. Vertical cup-discs ratios were assessed on dilated eyes with direct ophthalmoscopy. Intra-ocular pressure was assessed by Tonopen (Mentor). Ophthalmologists’ assessment of both parameters were standardized and validated before the study. The prevalence rate of glaucoma (as defined by disc and IOP criteria) and 95% confidence intervals of any glaucoma were estimated, allowing for clustering by households. Results: The overall age adjusted prevalence rate of probable open-angle glaucoma by disc criteria was 2.8% (95% confidence interval (CI), 1.7 to 3.9) and probable open-angle glaucoma by IOP criteria was 5.0% (95% CI, 3.6 to 6.4). Conclusion: The prevalence rates of glaucoma in provincial Sumatra, Indonesia provided by this study appear similar to other developing countries in Asia.

Conclusion: Bimatoprost is effective as monotherapy, replacement and adjunctive therapy for glaucoma and OHT patients in “real-life” clinical practices throughout Asia Pacific. Bimatoprost allows patients to reach low target IOPs and is well tolerated. ABS 83

MECHANICALLY ENHANCED TRABECULECTOMY

Muhammad Tayyib, Services Hospital, Pakistan Purpose: To assess the efficacy and post operative complications of the mechanically enhanced trabeculectomy in open angle glaucoma patients. Methods: 20 eyes of 15 patients underwent mechanically enhanced trabeculectomy. All these eyes had uncontrolled open angle glaucoma despite maximal medical therapy. Each patient had complete ocular examination prior to the surgery. Mechanically enhanced trabeculectomy was performed under peribulbar anesthesia in all patients except one who was operated under general anesthesia. The steps of this procedure are same as in a conventional trabeculectomy except the placement of 8/0 prolene suture between the partial thickness scleral bed with a loop of this suture communicating with the anterior chamber. Postoperative follow up was done at 1st week and 1, 3, 6 and 12 months. Results: The minimum follow up of the each patient was 12 months. Preoperatively mean intraocular pressure was 23.8 mmHg with maximal tolerated medical therapy. The mean postoperative intraocular pressure was 9.2 mm Hg at one week, 9.3 mm Hg at one month, 10.4 mm Hg at 3 months, 10.4 mmHg at 6 months and 11.2 mmHg at 12 months. The success rate was defined as intraocular pressure lower than 15 mm Hg without medications which was achieved in 95% of eyes at 12 months postoperatively, complications were significantly low. Conclusion: The success rate of mechanically enhanced trabeculectomy is much higher with fewer complications. This technique appears to be safe, quick, easy and inexpensive.

ABS 86 FACTORS ASSOCIATED WITH PRESSURE REDUCTION FOLLOWING PHACOEMULSIFICATION IN EYES WITH OCCLUDABLE ANGLES Catherine Jui-Ling Liu, Taipei Veterans General Hospital, Taiwan C.Y. Cheng, Taiwan; C.W. Wu, Taiwan Purpose: To determine the changes of intraocular pressure (IOP) after phacoemulsification with implantation of posterior chamber intraocular lens in eyes that had received peripheral iridotomy for occludable anterior chamber angles. Methods: After all the inclusion and exclusion criteria had been confirmed, patients were enrolled and diurnal IOPs were measured at 8:30 AM, 12:30 noon, and 4:30 PM with one calibrated Goldmann applanation tonometer one day before and 3 months after the surgery. Results: Forty patients completed the study whose mean IOP decreased from 14.2(3.6) preoperatively to 11.4(3.2) mmHg (P⬍0.001) 3-month postoperatively while the glaucoma medication decreased from 1.2(1.2) to 0.4(0.8) (P⫽0.000). Patients with primary angle-closure suspect (P⫽0.012), primary angle-closure ocular hypertension (P⫽0.008) or primary angle-closure glaucoma (P⫽0.006) all showed significant reduction of IOP at postoperative 3-month visit compared to the preoperative levels. With multivariate lineal regression analysis, a greater decrease of postoperative IOP is related to a history of acute attack (P⫽0.001), a larger radius of the cornea (P⫽0.001), higher preoperative mean IOP (P⫽0.000), and less preoperative glaucoma medications (P⫽0.000). Conclusion: Postoperative IOP decreased significantly following phacoemulsification and intraocular lens implantation in eyes with narrow angles, no matter whether there is a history of elevated IOP or whether there is evidence of glaucomatous optic neuropathy or not.

ABS 84 OPTIC NERVE HEAD CHARACTERISTICS OF NORMAL HEALTHY MALAYS USING HEIDELBERG RETINAL TOMOGRAPH II (HRT II) Andrew Lim Keat Eu, Universiti Sains Malaysia, Malaysia Shawarinin Jusoh, Malaysia; Puneet Agarwal, Malaysia Purpose: The utilization of confocal laser scanning ophthalmoscope: 1. To determine normal optic nerve head parameters in a healthy Malay population. 2. To study the age and gender differences in optic nerve head parameters. 3. To study the inter-ocular differences in optic nerve head parameters. Methods: This is a cross-sectional study involving 92 healthy Malay volunteers. Exclusion criteria included significant ocular diseases, family history of glaucoma, raised intraocular pressure and abnormal visual fields. Both eyes of the volunteers were subjected to optic nerve head topography using HRT II. Results: There were 34 males (mean: 39.34 ⫹/⫺ 9.27, 23-54 years) and 58 females (mean: 33.29 ⫹/⫺ 8.55, 23-52 years). Optic nerve head parameters of the Malay population include disc area ⫽ 2.46 ⫹/⫺ 0.48mm2, cup area ⫽ 0.53 ⫹/⫺ 0.43mm2 and retinal nerve fibre layer cross sectional area ⫽ 1.47 ⫹/⫺ 0.40mm2. Mean horizontal cup-disc ratio (CDR), vertical CDR and linear CDR were 0.45 ⫹/⫺ 0.20, 0.31 ⫹/⫺ 0.21 and 0.43 ⫹/⫺ 0.16 respectively. Mean inter-ocular difference in vertical CDR was 0.14 ⫹/⫺ 0.15. Linear correlations were noted between disc area and rim area, and disc area and cup area. Gender and age of patient did not influence the optic nerve head parameters. Conclusion: HRT II provides objective and quantitative assessments of the optic nerve head. However normative data is essential to differentiate optic nerve head glaucomatous damage from normal. This study provides this required normative data for the Malay population.

ABS 87 POLYMORPHISMS IN THE IL-1 GENE CLUSTER ASSOCIATED WITH REDUCED RISK FOR PRIMARY OPEN ANGLE GLAUCOMA (POAG) IN CAUCASIANS Chun Yuan Wang, Taichung Veteran General Hospital, Taiwan M. Elizabeth Fini, USA Purpose: This study set out to test the hypothesis that IL-1a and Il-1␤ variants (IL-1a(⫺889T), IL-1␤(⫺511T) and IL-1␤(⫹3953T) alleles), which result in increased secretion of IL-1a and IL-1␤, will reduce the risk of POAG. We have previously reported that expression of the endothelial leukocyte-adhesion molecule (ELAM)-1 by TM cells is a diagnostic marker of glaucoma. ELAM-1 expression is controlled by activation of an IL-1 autocrine feedback loop. In our previous study, short-term upregulated endogenous IL-1 was shown to protect TM cells against oxidative stress and lower IOP. In an in vitro test, IL-1a(⫺889 T) allele increased

ABS 85 PREVALENCE RATES OF GLAUCOMA IN RURAL SUMATRA, INDONESIA Allan Fong, Singapore National Eye Centre, Singapore Saw Seang Mei, Singapore; Rahat Husain, United Kingdom

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the IL-1a protein level with respect to the IL-1a (⫺889C) allele; and two polymorphic IL-1␤ variants, (⫺511T) and (⫹3953T), both have increased IL-1␤ secretion. Methods: We assessed genomic DNA from 147 people with POAG and 136 normal people by polymerase chain reaction-based analysis. Logisticregression methods were used to determine the potential effect of each genotype and allele and the interaction between them on the risk of glaucoma. Results: In our Caucasian group, we identified a single nucleotide polymorphism, IL-1␤(⫹3953C-T), that had a significant association with protection from POAG (Odds ratio 0.51, 95%CI 0.27– 0.96, P ⫽0.036). The allele frequency of IL-1a(-889T) was higher in the normal control group (39%) than in the glaucoma group (29%, P ⫽0.04). The genotype or allele frequencies of IL-1␤(⫺511C/T) showed there was no difference between the POAG and the control groups. There was the same tendency in the joint group. Conclusion: IL-1␤(⫹3953T) polymorphism may be a protective marker against POAG. There was a trend for a lower POAG risk in homozygote TT of IL-1a(⫺889). Targeted interventions to increase endogenous IL-1␤ secretion during stress could provide preventive and therapeutic strategies against POAG. ABS 88 COMPARISON OF EVALUATION OF OPTIC NERVE HEADS BETWEEN GLAUCOMA SPECIALIST AND RESIDENT USING PHOTOGRAPHIC PLANIMETRY AND HEIDELBERG RETINA TOMOGRAPH II Satoshi Mukai, Hiroshima University Graduate School of Biomedical Sciences, Japan Eiichiro Sugimoto, Japan; Hiromu K. Mishima, Japan Purpose: To compare the evaluation of optic nerve heads by the glaucoma specialist with that by the resident. Methods: Optic nerve heads were analyzed morphometrically by planimetry of color optic nerve head photographs and by Heidelberg retina tomography (HRT II) as the confocal scanning laser tomography. The glaucoma specialist and the resident evaluated optic nerve heads by rim to disc area (R/D) ratio. The correlation of the mean deviation (MD) of Humphery visual field analyzer 30-2 and R/D ratio was also evaluated. Results: Twenty-five eyes of 15 patients were evaluated. With planimetric evaluation of photographs, R/D ratio was 0.36⫾0.10 and 0.46⫾0.13 by the glaucoma specialist and by the resident, respectively. With HRT II, R/D ratio was 0.40⫾0.15 and 0.40⫾0.16 by the glaucoma specialist and by the resident, respectively. With planimetric evaluation of photographs, R/D ratio measured by the glaucoma specialist was significantly (p⬎0.001) smaller than that by the resident, while no significant difference (p⫽0.3) was found between the glaucoma specialist and the resident using HRT II. R/D ratios measured by the glaucoma specialist and the resident with either photographs or HRT II were all significantly correlated to MD. Among those, R/D ratio measured by the glaucoma specialist with planimetry of color optic nerve head photographs was most correlated. Conclusion: Optic nerve head evaluation may differ from the experience of the ophthalmologists with planimetric evaluation of photographs, while the experience of the ophthalmologist does not affect optic nerve head evaluation with HTR II. ABS 89 CLINICAL COMPARISON OF PROVIEW PHOSPHENE TONOMETRY AND GOLDMANN TONOMETRY Tengku Ain Fathlun Tengku Kamalden, University Malaya Medical Centre, Malaysia Mimiwati Zahari, Malaysia; Sharma Ann Jesudass, Malaysia Purpose: This study aimed at comparing the difference in intraocular pressure measured with Goldmann tonometry and the Proview phosphene tonometry. This comparative case series involved a total of 198 eyes from 100 patients without diagnostic specificity. Results: In all range of intraocular pressures without diagnostic specificity, the mean difference between the two techniques was 1.20 mmHg. Thirty-seven percent of the measurements were within ⫾ 1 mmHg, and 50.5% of the measurements were within ⫾ 2 mmHg. The mean intraocular pressure difference was the smallest at 0.62 mmHg (p⫽0.281)

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between the range of 18-21mmHg (as measured by Goldmann tonometry), and largest at 7.18 mmHg (p⫽0.035 ) for intraocular pressure range between 22 – 25 mmHg. For values below 18 mmHg, Proview phosphene tonometry reading was not accurate (p⬍0.05). Conclusion: The Proview phosphene tonometer is a simple tool which allows self-monitoring of intraocular pressure, however this study showed it has a limited range of accuracy. ABS 90 INTERFERON BETA-1A IN MULTIPLE SCLEROSIS PATIENTS WITH OPTIC NEURITIS AT TAIWAN An-Guor Wang, Taipei Veterans General Hospital, Taiwan Yen-Ching Lin, Taiwan; May-Yung Yen,Taiwan Purpose: To investigate the clinical response of interferon beta 1-a in patients with multiple sclerosis (MS) and optic neuritis (ON) at Taiwan. Methods: A total of 20 patients (18 women, 2 men) with clinical diagnosis of MS with optic nerve involvement in Taipei Veterans General Hospital from 1993 to 2003 were enrolled in this study. Patients were divided into Rebif group which comprised 10 patients who received Rebif (interferon beta-1a) 22 ␮g subcutaneously three times weekly, and Control group with 10 patients without interferon treatment. Mean treatment duration of Rebif was 25 months. The demographic data, clinical and paraclinical results, and the disease course of these 20 MS patients with ON were retrospectively analyzed. The main outcome measures were the recurrence of ON or other neurologic attack, and final visual outcome. Results: Annualized relapse rate did not differ between the pre-treatment period and the post-treatment period within the Rebif group. It is not significantly decreased in the post-treatment period of Rebif group, even compared with the control group. We observed an early recurrence of optic neuritis in 50% of the cases following the use of interferon beta-1a. The final visual outcome did not differ between treatment groups. Conclusion: Early relapse of optic neuritis may complicate the use of interferon beta-1a. The annualized relapse rate and final visual outcome did not differ between treatment groups at 2 years. ABS 91 EPIDEMIOLOGICAL STUDY OF CENTRAL CORNEAL THICKNESS AND INTRAOCULAR PRESSURE IN MALAYSIANS Carmen Chew, Hospital Kuala Lumpur, Malaysia Mokhlisoh M. A., Kuala Lumpur Jelinar M. N., Kuala Lumpur Purpose: To describe the normal distribution of central corneal thickness (CCT) and evaluate its relationship to intraocular pressure (IOP) in the three major races in Malaysian population. Methods: 1,000 Malaysians, aged between 21-80 years, of Malay, Chinese, or Indian descendants, who consents to participate, received a standardized examination, including automated refraction, ultrasonic pachymetry (Corneo-gage plus 2), applanation Goldmann tonometry and comprehensive ophthalmologic evaluation. Results: There are 866 Malaysian participants and 1752 eyes were analyzed. The racial breakdown was Malay 442 (51.0%), Chinese 288 (33.3%) and Indian 136 (15.7%) of which 66.4% were females. The mean age was 43.5 years, ranging from 20 to 82 years. The mean CCT was 543.07micron SD⫹32.22. There was no significant difference in mean CCT between races in matched age groups. However, decreasing values of CCT were associated with increasing age. The mean IOP was 15.31mmHg SD⫹ 2.67. There was no significant difference in mean IOP between races in matched age groups. An increasing reading of IOP was associated with increasing age. Conclusion: The mean CCT in a multiracial community is comparable to that reported in other predominantly Caucasian population. ABS 92

MIGRAINE CURVE–A NEW CONCEPT

Md Enamul Hoque, Rajshahi Medical College, Bangladesh Purpose: While dealing with migraine patients, it has been observed that intensity and frequency of migraine pain is directly proportional to

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Results: The patients age ranged from 16 to 66 years with a mean ⫾ std. Deviation (41.7 ⫾ 31.1) years. 56% are male. Fourteen patients were operated by TC. Preoperatively, visual acuity deficit occurred in 64% vs 96% (TS vs TC, p⫽0.011). Postoperatively, visual acuity (VA) returned to normal in 37.5% in TS and 22.2% in TC (p⫽0.186), improved in 30% in TS and 33.3% in TC (p⫽0.773), no change in 17.5% in TS and 29.6% in TC (p⫽0.243) and worsened in 15% in TS, 14.8% in TC (p⫽0.742). Visual field (VF) defect occurred in 54% vs 82% (TS vs TC, p⫽0.034) preoperatively. Postoperatively, VF returned to normal in 37.1% in TS, 21.7% in TC (p⫽0.215), improved in 17.2% in TS, 26.1%inTC (p⫽0.623), no change in 40% in TS, 39.2% in TC (p⫽0.947) and worsened in 5.7% in TS, 13.0% in TC (p⫽0.621). There was no significant difference in improvement of visual function between TS and TC, (VA, p⫽0.786 and VF, p⫽0.710). Complications were observed more in TS surgery. Conclusion: 1. Visual function improves significantly after both techniques of surgery. No significant difference noted between the two techniques. 2. TS had more visual improvement compared to TC 3. Complications were more in patients who had undergone transphenoidal surgery.

tension. Similarly the duration of pain has also been found to be dependent upon grades of tension. Considering these two observations, 200 patients of common migraine areis studied, whether a migraine pain curve can be drawn or not where x-axis is magnitude or intensity and y-axis is duration of pain for each patient and it is to see how this curve helps in managing the migraine patient and also to see whether the drug treatment can influence it. Methods: 200 patients of common migraine were categorized into different grades of tension (t1, t2, t3) according to selected tension grade criteria. After that, magnitude of pain (m1, m2, m3) was assessed with pre-selected grade for each patient. To see the duration (d), for every grade of tension - total duration and also time of peak level of pain was recorded. To see the effect of drugs, 106 patients were selected among 200 patients, and selected dose of drug was given at 20th minute, at l0th minute and at 5th minute of starting of pain and time was recorded up to the abort of pain. Results: Among 106 patients, 12 patients were tension grade 1 (t1) who experienced pain of magnitude grade I (ml) with duration pain 3:42h, raised average peak level of pain at 0:27h and pain aborted after 4:06h. Similarly, among 106 patients, t3 was 57, where m3 was 17 and m4 was 50 and duration of pain ’d’ was 4:12h & 4:42h respectively. In the next 52 patients, t1 was 12, where m1 was also 12 but t3 was 25 and m3 was 6 and m4 was 19 patients. Total duration of time ’d’ was 4:31h, 5:16h and 6:01h respectively for every grade of pain with average peak level of pain of 5:16h. If we consider the above data, then a Curve can easily be drawn which will be presented in details. This data reveals that ‘m’ depends upon ‘t’ that is ‘m’ ⬁ ‘t’ and ‘t’ is also depends ‘d’ that is ‘d’ ⬁ ‘t’. Drug applied at 20th minute of pain curve, it was aborted at 3:32h. But applied at 5th minute, it was aborted after 00:45h. Conclusion: It may be concluded from the study that a migraine curve can be drawn for each patient. This curve gives the idea of total gravity of patient that helps to plan the treatment and rational measurement to prevent it. Earliest start will decrease the intensity as will as duration of pain. Both the patient and physician have to consider migraine curve for better outcome. ABS 93

ABS 95 EXPRESSION OF OPA1 IN THE RETINA AND OPTIC NERVE May-Yung Yen, Taipei Veterans General Hospital, Taiwan An-Guor Wang, Taiwan; Ming-Ji Fann, Taiwan Purpose: Autosomal dominant optic atrophy is the most frequent form of hereditary optic neuropathy. Genetic linkage studies mapped a dominant optic atrophy gene (OPA1) chromosome 3q28-qter. Forty-two mutations in OPA1 gene on patients of dominant optic atrophy have been reported. The function of the OPA1 protein is still unknown. Our aim in this project is to investigate the OPA1 protein expression on retina. Methods: The cDNA encoding a C-terminal peptide (amino acids 647-808) of human OPA1 protein was amplified with high fidelity PCR and cloned into pET29a. His-OPA1 Fusion Protein was induced by IPTG in DE3 cells containing pET29a-OPA1. The induced 24 kD bands was purified by metal chelating column. A rabbit polyclonal antibody was generated against this fusion protein. Western blot and immunohistochemistry were used to examine the expression of OPA1 in the retina and optic nerve of human and mice. Results: In the tissue, the molecular weight of the recognized protein was about 105 kD. This 105 kD band was present abundantly in the human retina. Immunohistochemistry showed that OPA1 was expressed mainly over the superficial layer of inner retina, optic nerve head, and in the optic nerve proper. Conclusion: OPA1 gene is mainly expressed in the nerve fiber layer and retinal ganglion cells of retina, and over the astrocytes of the optic nerve.

PTOSIS IN PATIENTS WITH CEREBRAL STROKES

Sanjoy Chowdhury, Bokaro General Hospital, India Purpose: Cerebral ptosis is rare but its frequency in patients with strokes has not received systematic study. To determine the frequency of ptosis in patients with acute hemispheric stroke and to identify stroke features associated with ptosis. Methods: Eyelid function was studied in 48 consecutive patients with acute hemispheric stroke and 40 age-matched subjects with no known neurological disease. All underwent comprehensive neuro-ophthalmologic and general neurological examination within 48 hours of admission, including measurement of palpebral fissures, marginal reflex distance, and range of upper lid movement. Results: 12 cases (25%) had ptosis which was bilateral in 2 and unilateral in 10. In one patient with large hemispheric infarction, complete bilateral or asymmetric ptosis was the first sign of imminent herniation, preceding pupillary dilation and ocular motor deficits. Conclusion: Ptosis occurs frequently in patients with hemispheric strokes, especially in association with right hemispheric lesions. Complete bilateral ptosis is usually caused by large infarctions and may be a premonitory sign of an impending herniation.

ABS 96 OPTIC NEURITIS: A 10-YEAR RETROSPECTIVE STUDY IN NATIONAL TAIWAN UNIVERSITY HOSPITAL Chen Chao-Sun, National Taiwan University Hospital, Taiwan Huang Jen-Shang; Jou Jia-Ren Purpose: To describe the baseline characteristics of local patients with optic neuritis. Methods: We carried out a 10-year (1993-2003) retrospective review of the medical records of patients with the clinical diagnosis of optic neuritis. 407 patients were identified. Age of onset, sex, initial symptoms and visual acuity, treatment modality, underlying disease, neuroimaging, number of recurrences, interval between recurrence and subsequent conversion to multiple sclerosis (MS) were recorded. Results: 74 patients were included by the inclusion criteria. The male to female ratio and the average age were similar to published studies. But significant fewer optic neuritis patients in Taiwan have the symptom of ocular pain. Steroid was more often prescribed for patients with poor initial vision. Conclusion: Most of the baseline characteristics of optic neuritis patients in Taiwan were similar to those in other countries.

ABS 94 CHANGES IN VISUAL FIELD DEFECT: POST-PITUITARY TUMOUR RESECTION COMPARISON BETWEEN TRANSPHENOIDAL AND TRANSCRANIAL APPROACHES Hanizasurana Bt Hashim, Mentakab Hospital, Malaysia Che Muhaya Mohamad, Malaysia Purpose: To compare patients with pituitary adenoma who underwent transphenoidal(TS) and transcranial(TC) surgery, the visual outcome and postoperative complications. Methods: Retrospective analysis of case notes of 45 patients {(90 eyes) 14 TC, 31 TS} with pituitary adenoma who underwent pituitary tumour resection between 1998 and May 2002.

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ABS 97 OCULAR HYPERTENSIVE RESPONSE TO TOPICAL STEROID IN NORMAL ADULT CHINESE Lam Sze-Wing, Prince of Wales Hospital, Hong Kong Ng Siu-King Joan, Hong Kong Chong Kam-Lung Kelvin, Hong Kong Purpose: To study the ocular hypertensive response to a standard regime of topical ophthalmic steroid in normal Chinese adults. Methods: This study is a prospective case series. Consecutive Chinese patients aged 18 or above who underwent standard primary pterygium excision during the period 1 July 2002 to 31 March 2003 were recruited. All patients were given dexamethasone containing eye drops four times a day for six weeks postoperatively. Intraocular pressure (IOP) were measured within 1 week preoperatively, and then at 1 week, 3 weeks, 6 weeks and 8 weeks postoperatively. Results: A total of 138 patients were recruited. One hundred and twelve patients completed the study. Twenty of 112 patients (17.8%) had and elevation of IOP ⬎ 5mmHg and was considered steroid responders. The elevation of IOP can be as much as 3 folds from the baseline. The topical steroid response rates in patients of age below 50, from 50-65, and above 65 years were 29.3%, 16.7% and 5.7% respectively. Fifty percent of responders responded within 3 weeks from the commencement of topical steroid. The IOP of all responders returned to the baseline 2 weeks after stopping topical steroid eye drops. Conclusion: Ocular hypertensive response is common in normal Chinese adults. The rate of response is greater in the younger age groups. Patients, especially children and young adults, on topical steroid should have their IOP monitored, even in short period of use and lack of any suspicion of glaucoma. ABS 98 EARLY DIAGNOSIS OF THE PAPILLORENAL SYNDROME BY OPTIC DISC MORPHOLOGY Arif O. Khan, King Khaled Eye Specialist Hospital, Saudi Arabia Sawsan R. Nowilaty, Saudi Arabia Purpose: In the absence of recognized family history, the diagnosis of papillorenal syndrome is typically not made until renal disease is evident. We report the case of an infant whose ophthalmic findings led to the early diagnosis of the papillorenal syndrome. Method: Retrospective case report. Results: A 7-month-old male referred for suspected glaucomatous cupping was found to have optic nerve morphology classic for the papillorenal syndrome, i.e., central excavated discs with multiple cilioretinal arteries. Doppler imaging confirmed low central retinal artery flow OU as well as unilateral renal dysgenesis .The father, who had a history of idiopathic renal failure in his early 30s, was found to have similar optic nerve findings. Conclusion: Although optic disc features in the syndrome can vary, the classic optic disc features of the papillorenal syndrome - central excavated discs and multiple cilioretinal arteries – are pathognomonic for the syndrome. Early diagnosis is important, as prophylactic systemic antihypertensive treatment can limit renal morbidity. ABS 99 HOMONYMOUS VISUAL FIELD DEFECT CAUSED BY SKULL METASTASIS FROM HEPATOCELLULAR CARCINOMA Sheng-Yao Hsu, Tzu Chi Medical Center, Taiwan Fang-Ling Chang, Taiwan; Rong-Kung Tsai, Taiwan Purpose: Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms in Asia. The annual incidence is up to 500 cases per 100,000 populations. HCC is four times more common in men and usually arises in a cirrhotic liver. Hepatocellular carcinoma commonly metastasizes to the lung, regional lymph node, peritoneum, and adrenal glands. HCC skull metastasis is a relatively rare condition. Recently, we found a male patient had homonymous visual field which was caused by HCC skull metastasis. Method: Case report. Results: A 53 years old male patient suffered from blurred vision on right visual field for two months on August 2004. Besides, there was a

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protruding mass over left parietooccipital area since 4 months ago. Autoperimetry showed right homonymous hemianopia. Head magnetic resonance imaging (MRI) showed a mass in the left parietooccipital cranium with osteolytic change and compressed left posterior horn and left cerebral sulci without brain metastasis. Besides diabetes and liver cirrhosis, he had been diagnosed with HCC since Jan 2004 and had received transarterial chemoembolization three times till now. The patient received selective embolization and left parietooccipital craniectomy by neuro-radiologist and neurosurgeon in September 2004. The pathologic study showed parietooccipital bone metastasis by hepatocellular carcinoma and dura free of metastasis (Figure 3B). One month later, the repeated autoperimetry showed normal visual field. Conclusion: Skull metastases are frequently seen with bronchogenic, breast, and prostate cancer; from HCC is a rare event. Our report, being the first case, represents a very rare skull metastasis without brain or dura metastasis from HCC presenting with right hemianopsia and visual field defect improvement rapidly after surgery. ABS 100 VISUAL OUTCOME OF OPTIC NEURITIS IN SYSTEMIC AUTOIMMUNE DISEASE Chih-Wei Wu, Taipei Veterans General Hospital, Taiwan May-Yung Yen, Taiwan; Yen-Ching Lin, Taiwan Purpose: To report the clinical experience in the management of optic neuritis (ON) in systemic autoimmune disease. Methods: Retrospectiv analysis of patients with ON due to systemic autoimmune disease in Taipei Veterans General Hospital from January 1986 to December 2003. Results: Nine patients with ON due to autoimmune disease were enrolled. All were female. Five patients had systemic lupus erythematosus, the other four were rheumatoid arthritis, Sjogren syndrome, mixed connective tissue disease, and anti-phospholipid syndrome respectively. Serological tests revealed positive evidence of vasculitis with a positive anti-nuclear antibody in seven patients (78%) at the onset of ON. Four patients showed excellent visual recovery after early intervention with standard methylprednisolone pulse therapy. However, the remained five patients with oral prednisolone therapy or delayed treatment lost their vision eventually. Conclusion: Autoimmune ON often responds well to early treatment with high-dose corticosteroids. Early diagnosis and prompt treatment is important for restoring visual function in these patients. ABS 101 MONOCULAR VISUAL LOSS CAUSED BY MUCOCELE AND ARTERIO-VENOUS MALFORMATION–A CASE REPORT Chiao-Ying Liang, Taichung Veterans General Hospital, Taiwan Hin-Yeung Choi, Taiwan Purpose: To present a case of compressive optic neuropathy caused by a mucocele and a huge arterio-venous malformation. Metho: A case report. Results: A previously healthy 52-year-old male complained of painless, progressive vision loss in the left eye over the course of 4 days. The visual acuity was 6/7.5 OD and 6/60 OS, and the left pupil showed relative afferent papillary defect (RAPD). The external eyes, motility, and slit lamp examinations were normal. Dyschromatopsia without specific pattern of the left eye was noted. Visual field testing showed full field of the right eye and total depression of the left eye. The fundus examination was normal in both eyes, except slight congestion of the left optic disc. The visual evoked potential (VEP) showed normal response of the right eye and no response of the left eye. MRI showed a huge AVM of the left frontal lobe parenchyma, and a mucocele formation of sphenoid sinus, which caused left optic canal narrowing. Under the impression of compressive optic neuropathy, the patient first received methylprednisolone pulse therapy then surgical decompression of the optic canal. After surgery, the vision of left eye rapidly recovered to 6/6.7, and the visual field test showed full fields of both eyes. Conclusion: Compressive optic neuropathy should be carefully differentiated with retrobulbar optic neuritis. MRI of the brain and orbits were necessary to reveal brain or orbital compressive lesions. Early diagnosis

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