Escrs Virtual Wm 2022 Abstracts

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Sheet 1: EPosters

Abstract Final Identifier
Title
Presenting Author
Abstract Topic Name
Submitter First Name
Submitter Middle Name
Submitter Last Name
Submitter Country
Purpose
Setting
Methods
Results
Conclusion
Session 1 - Name
Session 1 - Presentation Start
Session 1 - Presentation End

P001
AMLODIPINE AS A NEW RISK FACTOR FOR INTRAOPERATIVE FLOPPY IRIS SYNDROME
Wafae Akioud
Cataract
Wafae

akioud
Morocco
The purpose of our study is to demonstrate that Amlodipine is a possible risk factor of IFIS for patients undergoing cataract phacoemulsification.
We have noticed a high rate of intra operative floppy iris sydrome among patients taking Amlodipine as a high blood pressure medication. We decided to conduct a unvirariate study called IFISAM to compare the incidence of IFIS between two comparative goupes ( age , gender , same inclusion criterias and same exclusion criterias ) with the variant being Amlodipine as HBP medication.
Included in IFISAM study, were 200 eyes of 200 patients who underwent cataract phacoemulsification with implantation of intraocular lens (IOL) in the posterior chamber. The following patient's information was collected: age ( fixated range between 50 and 65 yo ), gender, high blood pressure and its medication, diabetes millitus, pupillary diameter before and after dilatation, glaucoma and pseudo exfoliation syndrome. Were excluded all patients under alpha-blockers, finasteride or benzodiazepine, as well as patients with pseudo-exfoliation syndrome. Patients were classified as IFIS or non-IFIS after surgery. Univariate logistic regression analysis were performed.
The overall incidence of IFIS was of 12% (24/200 eyes). Among the patients classified IFIS after the surgery, 14 were under amlodipine as high blood pressure medication (58%).
Our study came to the prime conclusion that amlodipine might be a valid risk factor for developing IFIS .
Eposter
On-demand
On-demand

P002
IRVINE-GASS SYNDROME ASSOCIATED WITH ANTERIOR CHAMPER OINTMENT AFTER CATARACT SURGERY
Omar Shaker Al Adawi
Cataract
Omar Shaker

Al Adawi
Jordan
To report a case with Irvine-Gass syndrome caused by migrated intraocular ointment after uneventful cataract surgery.
A 68-year old female patient presented four months post uncomplicated cataract surgery complaining of tan buoyant substance in the anterior chamber which has been present since day one following the surgery.
This was consistent with Tobradex ointment migrated into the eye through the main wound into the eye. Obviously, there was no signs of anterior chamber inflammation. She was managed in the operating theater by burping the ointment through the prior clear corneal incision, followed by irrigation of the anterior chamber. Also, Irvine-Gass syndrome was detected three months following surgery, which was improved following removal of the bubble. Interestingly, similar case was presented with the same picture and treated accordingly as this case.
A case report.
The patient was managed in the operating theater by burping the ointment through the prior clear corneal incision, followed by irrigation of the anterior chamber and macular edema was improved following removal of the bubble
In this case, tobradex ointment had presumably migrated into the anterior chamber through a corneal incision after cataract surgery. The removal of the intraocular ointment improved macular edema. This is the second case in our department.
Eposter
On-demand
On-demand

P003
THE IMPORTANCE OF LENS THICKNESS FOR THE OCCURRENCE OF POSTERIOR CAPSULAR DEFECTS
Tschingis Arad
Cataract
Tschingis

Arad
Germany
During extracapsular cataract extraction (ECCE), the elastic lens capsule is left intact posteriorly as a space for intraocular lens (IOL) implantation. However, a posterior capsular defect may occur during the surgical procedure, requiring further surgical intervention. The purpose of this study is to investigate lens thickness at the occurrence of posterior capsular defects during cataract surgery.
Population-based study sample of patients treated at a university cataract and refractive surgery center.
Adult patients admitted for extracapsular cataract surgery via phacoemulsification and posterior chamber lens implantation between 2016 and 2019 were retrospectively analyzed.
Patients were identified using the patient database and surgical reports were reviewed for posterior capsular defects. Other factors as well as age, gender, and ocular biometry were recorded.
A total of 2325 eyes of 1967 patients (age: 70.56 ± 8.42, 1005 women; 962 men), were included. In 59 (2.54%) eyes an intraoperative posterior capsular defect was documented. In the majority of cases, no vitreous prolapse occurred (n=38, 1.63 %). In contrast, vitreous prolapse occurred in 12 cases (0.65 %), additionally with loss of lens components in 9 cases (0.52 %). The mean age of those affected was 70.95 ± 8.52 years (31 women, 28 men). Revision surgery was required in 25 cases during follow-up. The mean length of stay was 2.98 ± 2.30 days.
Ocular biometry measurements (n = 59) revealed a mean lens thickness of 4950.36 ± 466.63 µm, axial length of 23.73 ± 1.77 mm with a mean keratometry of 30.33 ± 17.47 dpt and an anterior chamber depth of 3.02 ± 0.71 mm.
A Wilcoxon-Mann-Whitney test was significant for lens thickness (p = 0.01) and anterior chamber depth (p = 0.03) with moderate relevance regarding effect size according to Rosenthal (lens thickness R = 0.34; anterior chamber depth R = 0.29).
In this series, the complication of posterior capsular rupture occurred in 59 of 2325 cataract surgeries.
Posterior capsular defect was shown to be influenced by variations in ocular biometry with respect to lens thickness and anterior chamber depth.
Posterior capsular defects occurred infrequently but produced significant consequences, including higher resource utilization due to the number of revision procedures.
Eposter
On-demand
On-demand

P004
ACHIEVING FUNCTIONAL TRIFOCALITY: EARLY FUNCTIONAL RESULTS OF A BINOCULAR DIFFRACTIVE TRIFOCAL INTRAOCULAR LENS SYSTEM
Gerd Uwe Auffarth
Cataract
Gerd
Uwe
AUFFARTH
Germany
To evaluate the clinical outcomes of a trifocal (MIOL), diffractive binocular intraocular lens system (Artis Symbiose, Cristalens Industrie, France), where one lens exhibits an extended depth of focus profile for intermediate vision (Artis Mid) and the other lens for near vision (Artis Plus).
International Vision Correction Research Centre (IVCRC), Dept. of Ophthalmology, University of Heidelberg, Germany
The first results of this ongoing clinical study include 4 patients who underwent phacoemulsification due to cataract with implantation of the MIOL (Artis Symbiose, Cristalens Industrie, France). Subjective refraction, corrected and uncorrected visual acuity, monocular and binocular [logMar] for distance, intermediate and near vision, as well as a binocular and monocular best-corrected defocus curve analysis were evaluated 3 months after surgery
Median binocular UDVA, UIVA and UNVA at 3 months postoperatively were 0.00 logMAR (range -0.08 to 0.10 logMAR), 0.00 logMAR (range -0.10 to 0.02 logMAR), and 0.00 logMAR (range 0.00 to 0.40 logMAR), respectively. Median binocular CDVA, DCIVA and DCNVA at 3 months postoperatively were 0.00 logMAR (range -0.10 to 0.08 logMAR), 0.00 logMAR (range -0.10 to 0.10 logMAR), and 0.00 logMAR (range 0.00 to 0.30 logMAR). The binocular distance-corrected defocus curve at 3 months showed a continuous visual acuity of 0,20logMAR or better in the range of +0.5 to -2.5 diopters of defocus
The initial results indicate good visual acuity at far, intermediate, and near distances, as well as throughout a wide range of defocus. Evaluation of visual acuity outcomes at 6 months postoperatively is ongoing
Eposter
On-demand
On-demand

P005
FIRST FUNCTIONAL RESULTS AFTER IMPLANTATION OF AN EDOF - IOL WITH A COMPLEMENTARY OPTIC SYSTEM USING SPHERICAL ABERRATION DISTRIBUTION
Gerd Uwe Auffarth
Cataract
Gerd
Uwe
AUFFARTH
Germany
To assess the visual und functional outcomes of the SIFI Mini WELL® + SIFI Mini WELL Proxa® IOL (SIFI S. p. A., Italy) complementary optic system using spherical aberrations designed to bridge the gap in near vision (30-35 cm) and reduce spectacle dependence.
International Vision Correction Research Centre (IVCRC), Dept. of Ophthalmology, University of Heidelberg, Germany
After one month and 3 months post-operative we examined four patients who were implanted with the SIFI Mini WELL® in the dominant eye and the SIFI Mini WELL Proxa® in the non-dominant eye. Binocular uncorrected distance, intermediate and near vision was measured. On top, a binocular distance-corrected defocus curve was assessed. Photic phenomena were measured by means of the Halo and Glare Simulator
The mean binocular uncorrected distance visual acuity was 0,08 logMAR. The mean binocular uncorrected intermediate visual acuity was 0,04 logMAR and the mean binocular uncorrected near visual acuity was 0,11 logMAR. In a scope of +0,50 dpt up to -3,00 dpt, the binocular distance corrected defocus curve showed a visual acuity of 0,1 logMAR or better
The WELL Fusion™ Optical System (Mini WELL® + Mini WELL PROXA®) showed first good functional results in distance, intermediate and near visual acuity. A complete independence from spectacles can be reached with excellent quality of vision in all light conditions
Eposter
On-demand
On-demand

P006
YAG CAPSULOTOMY RATES AFTER PHACOEMULSIFICATION WITH HYDROPHOBIC AND HYDROPHILIC ACRYLIC INTRAOCULAR LENSES
Soukaina Bahti
Cataract
Soukaina

BAHTI
Morocco
To retrospectively evaluate the incidence of YAG laser capsulotomies for posterior capsule opacification (PCO) seen with hydrophobic and hydrophilic acrylic intraocular lens implants 12 months after surgery.
Departement Adult ophtalmology ,20 august hospital
120 eyes that had phacoemulsification with a continuous curvilinear capsulorhexis and implantation of either a hydrophobic or a hydrophilic acrylic posterior chamber IOL were evaluated in order to assess the incidence of PCO. 78 eyes received a hydrophobic IOL and 42 eyes received a hydrophilic IOL . A standardized surgical protocol was performed by surgeons. All surgical complications were excluded and all patients had standardized postoperative medication and follow-up.
With an average follow-up of 12 months in both groups, the incidence of posterior Nd:YAG laser capsulotomy for PCO was 14 % in the hydrophobic group and 38% in the hydrophilic group.
Intraocular lenses made from hydrophobic acrylic material are associated with a significantly reduced rate of Nd:YAG laser capsulotomies as compared with intraocular lenses made from hydrophilic acrylic material.
Eposter
On-demand
On-demand

P007
EVEN A SMALL STAR SHINES IN THE DARKNESS: REPORT OF PEDIATRIC MICROSPHEROPHAKIA SURGICAL TREATMENT
Renato Correia Barbosa
Cataract
Renato
Correia
BARBOSA
Portugal
Microspherophakia is a rare, usually bilateral, abnormality of the crystalline lens. It is characterized by reduced equatorial diameter and increased lens thickness. Although the prevalence of this disorder is not entirely known, it may be present in various ocular and systemic conditions, including Weill-Marchesani syndrome, Alport syndrome, homocystinuria and Marfan syndrome. It is usually associated with lens subluxation, resulting in a high degree of lenticular myopia and defective accommodation. Angle-closure glaucoma is a common finding and may be found at the initial presentation.
Surgical procedure and reported footage show the treatment of the left eye. The surgery was performed on 8th August 2020 by Dr. Rui Carvalho and Dr. José Alberto Lemos, in Hospital Pedro Hispano – ULSM.
Report of the surgical treatment of a 3-year-old female patient diagnosed with microspherophakia secondary to Marfan Syndrome, associated lens subluxation and zonular instability.
A 3-year-old female patient with a direct familiar history of Marfan syndrome presented with very high bilateral myopia of -20.0D, objectified by retinoscopy, and variable angle alternating esotropia. During follow-up examinations, lens subluxation was perceived, along with severe myopization of both eyes, and she was proposed to bilateral surgery. During the procedure, lens aspiration and anterior vitrectomy were performed. Due to severe zonular instability with complete capsular bag detachment, the intra-ocular lens (Akreos Adapt AO, Bausch + Lomb©) was implanted with scleral insertion, using a z-suture technique. During the 2-year follow-up period, the patient had 20/20 best-corrected visual acuity in both eyes, wearing bifocal glasses. She maintained a variable angle alternating esotropia.
Microspheraphakia is a rare but impactful condition mostly related to systemic syndromes that affect protein synthesis. Although most cases are associated with severe zonule instability, making it impossible to implant the intra-ocular-lens inside the capsular bag, the alternative method of scleral insertion shown in this report resulted in a positive functional outcome.
Eposter
On-demand
On-demand

P008
INITIAL RESULTS WITH A NON-DIFFRACTIVE, EXTENDED DEPTH OF FOCUS INTRAOCULAR LENS (IOL) IN PATIENTS TARGETED FOR EMMETROPIA
Ankur Barua
Cataract
Ankur

Barua
United Kingdom
To report on the first results in cataract patients implanted with a non-diffractive, extended depth of focus (EDOF) IOL. The optical design utilizes an increase of spherical aberration at the center of the lens that gradually reduces at the margins. The theory is that this design enables an increased range of functional vision.
An ongoing prospective case series of patients in a private clinic in Solihull, England
This is an ongoing, prospective case series of patients implanted bilaterally with this pre-loaded, non-diffractive EDOF IOL in a private clinic in Solihull, England. All patients underwent routine cataract removal using either phacoemulsification or femtosecond laser cataract surgery, followed by implantation of the IOL. All patients were targeted for emmetropia.
To date, 80 eyes have been implanted with this IOL with the first patients achieving good uncorrected distance visual acuity (UCDVA) and an average of N-8 (0.40 LogMAR) uncorrected near visual acuity (UCNVA) at 1-month post-operative. In global, pooled results (N=206 eyes), patients achieved a mean UCDVDA of 0.132 LogMAR (Max = 0.65/Min = -0.1 LogMAR) and a mean UCNVA of 0.322 LogMAR (Max = 0.6/Min = 0.1 LogMAR).
The use of greater spherical aberrations at the center of the optic appears to provide patients with a greater range of vision, compared to a standard monofocal IOL. In addition, our initial experience indicates that the diffractive-free design reduces patient visual complaints, including dysphotopsia. Although our experience is early, the design approach provides a high degree of patient satisfaction with good visual outcomes.
Eposter
On-demand
On-demand

P009
MANAGING ECTOPIA LENTIS
Rita Basto
Cataract
Rita

Basto
Portugal
Lens subluxation occurs when there is partial disruption or distension of the zonular fibers, leaving the lens displaced from its normal position. When subluxation is associated with hereditary diseases with development defects, it is called Ectopia Lentis (EL).
The clinical presentation and respective treatment depend on several factors, such as: age of presentation, degree of subluxation, best corrected visual acuity (BCVA) and associated ocular defects.
The aim of this work is to describe the therapeutic strategies implemented in EL cases observed at the Hospital Professor Doutor Fernando Fonseca, the associated challenges and complications, as well as the visual results of the different approaches.
Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
Retrospective analysis of 41 eyes of 24 patients with EL (32 cases associated with Marfan's Syndrome and 9 with Isolated Congenital Ectopia Lentis), observed between 2010 and 2020.
13 cases remained under conservative treatment, with a mean BCVA of 6/10 on the Snellen scale.
28 cases underwent lens extraction, with a mean age at surgery of 17.7 years. The mean preoperative BCVA was 2/10. In 17 eyes, the capsular bag (CB) was stabilized and centered, using a modified capsular tension ring (mCTR) with scleral fixation, followed by the implantation of a posterior chamber (PC) intraocular lens (IOL). In 7 cases, it was not possible to guarantee capsular support, opting for the implantation of an anterior chamber (AC) IOL with iris claw (n=3) or a PC-IOL with scleral fixation (n=4). In 4 cases, an intracapsular lens extraction with complete anterior vitrectomy was performed, with IOL not being implanted (n=1) or with AC-IOL implantation (n=3). Postoperative BCVA was 6/10+2 letters, with a mean gain of 4 lines+4 letters.
The complications observed were: partial extrusion of mCTR (n=2), extrusion of the scleral suture (n=1), subluxation of the IOL (n=4), opacification of the posterior capsule (n=5), phimosis of anterior capsule (n=2) and retinal detachment (n=3).
There is no statistically significant difference (p>0.05) between the choice of surgical strategy or the IOL implanted and visual gain.
There is no consensus on the best approach to EL. In cases where BCVA is ≥ 5/10 and no associated ocular pathology, correction of refractive error and periodic surveillance may be an option. When BCVA is not adequate or there are associated complications, surgical treatment should be recommended, with CB preservation and PC-IOL implantation being the first choice in our hospital.
EL commonly presents during childhood, is progressive and is associated with several anatomical and structural changes. These facts make this pathology a challenge for the most experienced surgeon, who may have to adapt the surgical technique according to the complications that may arise.
Eposter
On-demand
On-demand

P010
RELIABILITY OF INTRAOPERATIVE ABERROMETRY IN PREDICTING IOL POWER IN POST REFRACTIVE SURGERY EYES
Krinjeela Bazgain
Cataract
Krinjeela

Bazgain
India
To check the reliabilty of Optiwave refractive analysis (ORA) (The ORA™ System, WaveTec Vision, Inc, Aliso Viejo, California) in calculating IOL power in post-refractive surgery eyes.
The study was done in a tertiary care centre in North India.
A prospective study that included 16 eyes which had undergone kerato-refractive surgery in the past either Radial Keratotomy (RK) or Laser insitu keratomileusis (LASIK). They underwent either Femtosecond Laser Assisted Cataract Surgery (FLACS) or conventional phacoemulsification. IOL power was calculated using IOLMaster ( ZEISS IOLMaster® 500 Carl Zeiss Meditech, Jena, Germany) and ORA in all the patients and compared. The difference between the IOL power calculated by IOLMaster and ORA was evaluated.
Out of 14 patients (16 eyes) with visually significant cataract, aged 30 years and above, 6 were males and 8 females. Preoperative keratorefractive surgical procedure was LASIK in four eyes and RK in 12 eyes. Nine (56.3%) eyes underwent FLACS and Seven (43.7%) eyes underwent conventional phacoemulsification. In all patients, the implanted IOL power was based on intraoperative ORA. The difference in the IOL power calculated by IOLMaster and ORA was significant with a p-value of 0.00
In post-keratorefractive eyes with significant cataract, ORA is a more reliable predictor in calculating the IOL power in eyes undergoing either FLACS or conventional phacoemulsification.
Eposter
On-demand
On-demand

P011
REAL-WORLD EVALUATION OF BLENDED VISION WITH A REFRACTIVE LOW ADD EDOF IOL WITH BLUE LIGHT FILTER
Lena Beckers
Cataract
Lena

Beckers
Germany
To improve near vision, refractive segmental low add EDoF IOL with blue light filter and with good far and intermediate vision can be implanted in a blended vision model (target refraction in non-dominant eye: -1.5D, dominant eye 0.0D). The aim of this analysis was to assess the question whether patients also benefit from this blended vision model with regard to postoperative defocus capacity, halo and glare phenomena and stereoscopic vision.
All surgeries were performed at the Breyer-Kaymak-Klabe Eye Surgery and Premium Eyes in Duesseldorf, Germany, member of the International Vision Correction Research Center (IVCRC.net).
Patients (20 eyes of 10 patients) underwent bilateral implantation of refractive low add EDoF IOL with blue light filter (1.5D addition, Acunex Vario, AN6V; Teleon Surgical B.V., Netherlands). Target refraction was emmetropia in the dominant eye and -1.5D in the non-dominant eye. Three months after surgery, we assessed the real world binocular defocus capacity, halo and glare phenomena and stereoscopic vison.
The real world defocus curve showed significantly better intermediate and near vision compared to monofocal IOL. Halo & glare and stereoacuity were very similar to phakic eyes.
Blended vision with Acunex Vario provides excellent visual outcomes across a wide range of distances from far to intermediate up to 60 cm. The photopic phenomena are comparable with other refractive EDoF IOL, but better than diffractive EDoF IOL. We mainly implant this EDoF IOL in the Duesseldorf Formula model as blended vision. Thus, the patients can see far, PC and iPad distance and read usual book- and newspaper print without glasses and without suffering from photopic phenomena. However, small print reading is not possible as with diffractive trifocal MIOL.
Eposter
On-demand
On-demand

P012
FIRST EVALUATION OF A NEW REFRACTIVE LOW ADD EDOF TORIC IOL WITH BLUE LIGHT FILTER
Lena Beckers
Cataract
Lena

Beckers
Germany
The aim of this analysis was the evaluation of postoperative subjective refraction and rotational stability with a segmental, refractive extended depth of focus (EDoF) toric IOL with blue light filter.
All surgeries were performed by a single surgeon at the Breyer-Kaymak-Klabe Eye Surgery and Premium Eyes in Duesseldorf, Germany, member of the International Vision Correction Research Center (IVCRC.net).
Patients (n=10) underwent bilateral implantation of refractive low add EDoF toric IOL with blue light filter (+1.5D addition, Acunex Vario Toric, AN6VT; Teleon Surgical B.V., Netherlands). We assessed the subjective refraction and rotational stability after 3 months, postoperatively.
The subjective refraction and rotational stability was comparable to other toric IOL available.
Acunex Vario Toric is the only low add toric EDoF IOL with glistening free blue light filter available right now. Therefore, we do have a further possibility to provide our patients with astigmatism and presbyopia with an option for an advanced independency of glasses in refractive lens exchange and cataract surgery.
Eposter
On-demand
On-demand

P013
RADIO-INDUCED CATARACT IN A CHILD WITH A CEREBRAL MENINGIOMA
Mohamed Bentaleb
Cataract
Mohamed

Bentaleb
Morocco
There are many causes of cataracts. They can be post-traumatic, congenital, senile..., but also post-radiation.
In what follows, we will detail a case of a radio-induced cataract.
We received a 12 years-old child in the ophthalmology department. She had a follow-up, with oncologists, for a right temporal meningioma, for which, she benefited of several sessions of radiotherapy with a cumulative dose of 56 grays. The child consults for a progressive decline in visual acuity, appearing one and a half years after radiotherapy.
On clinical examination, in both eyes, we found visual acuities of 1/10, clear corneas and anterior segments showing anterior and posterior polar cataracts. At the fundus, the excavations were physiological, good macular reflections and there were no signs of radio-induced retinopathy.
Thus, we decided, after having carried out a pre-anesthetic assessment, to do a phacoemulsification of her cataract in the right eye and then 1 month later in the left eye.
The patient currently has a secondary cataract in her right eye for which she will benefit of a Yag laser.
Cataracts induced by ionizing radiations are due to numerous metabolic disorders which may affect some elements contained in the lens. The drop in glutathione (an antioxidant), the sudden onset of low molecular weight protein loss can coincide with the maturity of the opacification. There is also a large accumulation of molecular mass aggregates. These events will lead to a disruption of the ionic and phosphocalcic balances of the lens as well as glucose metabolism. There will be other cellular modifications. These changes will lead to the formation of abnormal lens fibers which will migrate to the subcapsular regions leading to opacifications of these regions. The cumulative threshold dose for locoregional radiotherapy is> 5Gy.
The management of these cataracts is similar to that of senile cataracts. The secondary opacification rate would be less frequent.
The radiation-induced cataract is a rare pathology, which occurs in children, the risk of amblyopia leads us to take care of it urgently.
Eposter
On-demand
On-demand

P014
COMPARATIVE CLINICAL STUDY OF SURGICAL PERFORMANCE OF QUATERA 700 WITH MEMBRANE PUMP VERSUS CENTURION AND SIGNATURE PRO PHACOEMULSIFICATION SYSTEMS
Sheetal Brar
Cataract
Sheetal

Brar
India
To evaluate the surgical performance of the new Quatera 700 with membrane pumps (Carl Zeiss Meditec) in different grades of cataracts by a single experienced surgeon and compare the same with the Centurion (Alcon) and Signature Pro (J&J) phacoemulsification systems.
Nethradhama Superspecialty Eye Hospital, Bangalore
A total of 90 non-consecutive eyes (n=30 eyes in each group) with LOCS grade 0-2 were recruited. Phacoemulsification with implantation of a foldable posterior chamber intraocular lens was performed by a single experienced surgeon through a 2.2 mm clear corneal incision. Chamber stability scores( 1- 4, 4 being the worst), fluid turnover per case and incidence of surge and intra-operative complications was assessed
Intra-operatively, the chamber stability scores were 1.15 ( Q-700) vs 1.7 ( Sig-Pro) and 2.3 (Centurion), p<0.005. There was no significant difference in the average phaco power used and fluid turnover per case between the three study groups ( p>0.05 for both). 2 eyes in the Centurion, 1 eye in the Signature Pro and no eye in Q-700 group had intraoperative PCR.
Early experience suggests the new Quatera-700 phaco system to have the best chamber stability and lowest complication rates compared to Centurion and Signature-Pro systems.

Eposter
On-demand
On-demand

P015
A REAL WORLD REGISTRY EVALUATION OF SATISFACTION, SPECTACLE INDEPENDENCE AND VISION OUTCOMES IN GERMAN PATIENTS IMPLANTED WITH A NOVEL WAVEFRONT-SHAPING PRESBYOPIA-CORRECTING IOL
Detlev Breyer
Cataract
Detlev

Breyer
Germany
To report Real World patient satisfaction, spectacle independence, visual disturbances and vision outcomes with the AcrySof IQ Vivity and AcrySof IQ Vivity Toric Extended Vision IOL models DFT015, DFT315, DFT415, and DFT515 in German patients evaluated through routine clinical practice.
Multicenter, ambispective registry study conducted in Europe, the UK and Australia evaluating the performance of bilaterally implanted AcrySof IQ Vivity and AcrySof IQ Vivity Toric IOL in a real world setting through routine clinical practice.
This is a sub-analysis of subjects enrolled from German sites to date. After a minimum of 3 months post-op follow up per local clinical practice standards, subjects implanted with the AcrySof IQ Vivity and/or AcrySof IQ Vivity Toric IOL underwent subjective vision satisfaction and spectacle independence with validated PROMs questionnaires and patient reports of visual disturbances. We present the first interim analysis of outcomes observed at the enrollment visit to date.
27 subjects were enrolled from four German sites. Mean UCDVA, UCIVA and UCNVA were -0.010±0.102, 0.088±0.117 and 0.212±0.150 logMAR, respectively. The need to wear glasses was low with subjects reporting never/rarely needing to wear eyeglasses in bright light to see up close 61.5%, at arm's length 84.6% or far away 88.4%. 92% were satisfied with their sight, and 88.5% reported no difficulty seeing to engage in an activity/hobby of their interest. Visual disturbances rates were low – reported 'None' for halos 92.3%, glare 84.6% or starbursts 96.2%. There are no unanticipated AEs to date.
In this first Real World assessment of patients bilaterally implanted in Germany with the AcrySof IQ Vivity and AcrySof IQ Vivity Toric Extended Vision IOL suggests high levels of post-operative patient satisfaction with low needs to wearing spectacles and experiencing mild to no visual disturbances.
Eposter
On-demand
On-demand

P016
INITIAL CLINICAL RESULTS AND QUALITY OF VISION WITH A NEW ENHANCED MONOFOCAL IOL
Detlev Breyer
Cataract
Detlev

Breyer
Germany
The purpose of this investigation is to evaluate a possible increase of the quality of vision in distances between far and intermediate range by using a new enhanced monofocal 'EDoF' IOL.
All surgeries were / will be performed at the Breyer-Kaymak-Klabe Eye Surgery and Premium Eyes in Duesseldorf, Germany, member of the International Vision Correction Research Center (IVCRC.net) by one single surgeon (Breyer).

In all eyes (n=18), a hydrophilic enhanced monofocal IOL (LENTIS® L-333, Teleon Surgical GmbH) was implanted. We retrospectively as part of a quality management of lenses assessed subjective refraction, monocular and binocular uncorrected and best distance corrected visual acuity for far and intermediate distances, and binocular defocus capacity after 3 months postoperatively. Halo and Glare phenomena are evaluated.
The new enhanced monofocal EDoF IOL allows unimpaired seeing at distance. LENTIS L-333 shows clinically significant enhanced EDoF effect in intermediate VA. Therefore, this IOL is an 'inbetween' solution of a monofocal and an EDoF IOL. No Halo and Glare were detected.
LENITS L-333 IOL is a very interesting alternative to classical monofocal IOL. This IOL enables a higher degree of independence from glasses than monofocal IOL (high safety and comfort level) without more photopic phenomena as in classical aspheric monofocal IOL. It is also possible to apply micro monovision and monovision blended vision (Düsseldorf formula) with these IOLs even achieve a higher independence from glasses.
Eposter
On-demand
On-demand

P017
COMPARISON OF SURGERY INDUCED REFRACTIVE CHANGES AFTER FEMTOSECOND LASER-ASSISTED CATARACT SURGERY IN PATIENTS WITH DIABETES MELLITUS TYPE 2.
Celeste Briceno-Lopez
Cataract
Celeste

Briceno Lopez
Spain
To assess refractive outcomes in type II diabetes mellitus adult population after femtosecond laser-assisted cataract surgery (FLACS).
Cátedra Alcon-FISABIO-UVEG
This prospective comparative study was developed with patients from FISABIO Ophthalmology Medical Centre (FOM). Each patient went through an exhaustive ophthalmologic and optometric evaluation. The sample comprised 236 subjects with senile cataracts, with LOCSIII grades from N2 to N4. The control group comprised 159 eyes, and the experimental group with type II diabetes mellitus (DM) had 77 eyes. Patients with dense cataracts (>N4) and previous corneal surgical procedures as well as any other corneal pathological condition that could compromise corneal integrity were excluded from the study. Horizontal and vertical corneal astigmatism (KH, KV) were determined using the Topcon KR-8100P autokeratorefractometer (Topcon, Tokyo, Japan). Subjective refraction, in vectorial components (M, J0, J45) and best corrected visual acuity (BCVA) were also measured. This study included eyes of patients scheduled to have FLACS using 60kHz IntraLase® (IntraLase, IntraLase Corp.). The medical and optometric revisions, were performed before, 24 hours and 3 months after surgery.
The variables compared in the analysis were, age, endothelial cell density, vertical and horizontal keratometric power, axis of corneal meridians, vector components of subjective refraction and BCVA before and after FLACS. The Kolmogorov-Smirnov normality test revealed that all the variables followed a non-parametric distribution (p<0,05). U Mann-Whitney's test for independent samples revealed significant differences in the horizontal corneal axis and BCVA between both groups before the FLACS (z= -2,485, p=0,013 and z= -3,653, p=0,000; respectively). Additionally, the mean value of KH measured for both samples showed lower values for the control group in each stage of the study. However, these differences were only significant in the KH measured 24 hours after the surgery (z= -2,083; U= 5131,5; p=0,037) between both groups.
Femtosecond laser-assisted surgery has showed comparable results, repeatability, and reproducibility to manual incision phacoemulsification. The control of certain parameters such as the position, width, length, and architecture of the incision turns FLACS is a reliable tool to predict surgically induced refractive errors, changes in refraction and biomechanical corneal parameters. Horizontal keratometric radii are different (p=0,037) when both groups are compared after FLACS. KH changed for the experimental group as seen on the 24 hours follow-up, although these changes are not clinically relevant due to the slight increase on the power of the corneal astigmatism. The initial KHwas steeper, and the axis of the astigmatism changed in counterclockwise direction on the diabetic group. Finally, the pachymetric outcomes, refraction and BCVA of diabetic and healthy patients are similar after FLACS.
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On-demand

P018
ENDOTHELIAL DETACHMENT IN FEMTOSECOND LASER-ASSISTED CATARACT SURGERY, AN UNEXPECTED COMPLICATION. A CASE REPORT.
María Dolores Díaz-Barreda
Cataract
María Dolores

Díaz-Barreda
Spain
To present an unexpected complication in femtosecond laser-assisted cataract surgery during the making of incisions.
The femtosecond laser can be used in cataract surgery, allowing us to create highly precise three-dimensional incisions according to their location, depth and shape, as well as to carry out a correct and perfectly controlled capsulorhexis and fragmentation of the crystalline lens.
Based on the phenomenon of photodisruption by optical decomposition, the laser generates ultra-short infrared pulses specifically in the focused plane. This allows it to ionise electrons that collide with each other, producing the vaporisation and mechanical modification of the tissue on which we want to act without affecting the immediately surrounding tissue. It also helps to minimise the energy required during phacoemulsification and thus minimises the loss of endothelial cells.
We present a femtosecond laser-assisted cataract surgery for the performance of the incisions (both paracentesis and main), capsulorhexis and lens fragmentation. During the making of the main incision, the energy and morphology planned for the femtosecond laser were not enough to achieve an adequate corneal perforation. The energy released by the photodisruption phenomenon generated an air bubble that was trapped between the corneal stroma and the Descemet in a perincisional location.
The manipulation generated by the surgeon during the first steps of the surgery, especially the injection of intracameral fluids and anaesthetics without being aware of the alteration in the incisional architecture, generated a large-scale detachment of Descemet's layer.
During the otherwise uneventful phacoemulsification surgery, we noticed a significant endothelial loss as well as the surgeon's manoeuvres to try to adhere the Descemet's layer to the stroma once the problem was identified.
The femtosecond laser provides numerous advantages in cataract surgery, however, we must be prepared to deal with possible eventualities related to the application of the laser that may arise during surgery.
Eposter
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On-demand

P019
WORK EXPERIENCE OF'JORGE ALIO FOUNDATION FOR PREVENTION OF BLINDNESS' IN NOUADHIBOU (MAURITANIA) ON CATARACT ERADICATION
Jorge Alio
Cataract
Santosh

Dnyanmote
India
Highlight partnership model to facilitate modern eye care in Mauritania.
Eye hospital in Nouadhibou, Mauritania
Fundación Jorge Alió para la prevención de la ceguera envisioned the NOUADHIBOU VISION PROJECT in 2006 after a chance meeting with representatives of the local governing body. The idea was to create a modern eye care facility in Nouadhibou, which is second largest city in Mauritania with population of 200,000 people and nomadic tribes around this region. This region was deprived of any form of eye care not even basic optical services to prescribe glasses! Mauritania is an Islamic republic and african saharan country with population of over 4 million people. It has a total of 25 ophthalmologists in the whole country. Expeditions were organised to first study the country, its infrastructure or lack of it, eye problems and expectations of the population, attitude of the government organisations towards international eye care professionals etc.
Study the common ocular ailments seen in this country, availability of medications and prescription glasses.
Initially some basic awareness camps were organised followed by surgical camps. In the beginning handson training for the paramedical and medical staff was being conducted. Nursing staff was given orientation training in working of ophthalmic OPDs and later in operation theatre methods.
Teleconsultations were started in 2010 and local staff members were trained to connect the patients with the consultants in Spain.
Subsequently a full fledged eye hospital was created and the staff was trained for surgical procedures and to render post operative care locally. A pharmacy and optical stores were created and stuffed with all the medicines required for eye care.
Need for financial independance dictated that apart from donations collected globally it needed to be augmented by fees paid by the patients themselves. The fees remain extremely low for consulations, surgery and post operative care.

Thusfar a total of 15 expeditions have been carried out. As a result of these expeditions more than 10,000 people attended the OPD in the permanent eye hospital built in Nouadhibou. THe eye hospital is now equipped with two operation rooms housing a total of three operating microscopes, three phacoemulsifiers, autoclaving unit, fumigation unit as well as surgical tables and chairs. We have successfully carried out more than 800 cataract surgeries thusfar.

The Nouadhibou Vision Project has brought ophthalmological and optometric services to that area of Mauritania which was totally lacking it and was highly in need of such services
This model of partnership between doners and patients themselves through the fees they pay has proved in short time the viability and potential sustainability of the project to offer high quality services and very low cost for the patients.
The poor and underpriviledged population of a poor african saharan nation can now access modern eye care thanks to Nouadhibou Vision project
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P020
NEOVASCULARISATION OF THE LENS CAPSULE: A UNIQUE FINDING
Rida El Hadiri
Cataract
Rida

El Hadiri
Morocco
To report and discuss a case of neovascularisation of the lens capsule associated with proliferative diabetic retinopathy.
Mohammed V University, University Hospital Ibn Sina Rabat, Departement A of Ophthalmology, Morocco
we conducted a full clinical evaluation with ancilliary testing mainly a fundus fluorescein angiograpgy. we documented the findings by slit-lamp photography and scans. we also performed a cataract surgery by phacoemulsification
A 62 year-old man consulted for progressive loss of vision in both eye. His past ophthalmological history was unremarkable and he denied any known systemic condition. On examination, his best corrected visual acuity was light perception OU. Papillary reaction to light was sluggish OS and normal OU. Ocular motility was full OU with normal intra-ocular pressure. Slit-lamp examination showed bilateral white mature cataract with low pharmacological dilation. High magnification under dilation revealed a vascular network composed of fine vessels located nasally adjacent to the papillary border on the anterior capsule of the lens associated with pigment deposits and loss of the papillary frill (figure 1 a). There was no evidence of neovascularisation of the iris (NVI) or the angle (NVA). Ocular ultrasound was negative for vitreous hemorrhage or retinal detachment.
Ancilliary testing for diagnosis of common aetiologies of anterior segment neovascularisation was carried out and revealed type 2 diabetes. The patient was referred for evaluation and control of his newly diagnosed diabetes.
After six months, we performed an uneventful cataract surgery by phacoemulsification. Fundus fluorescein angiography (FFA) showed posterior segment ischemia with neovascularisation elsewere (figure 1 b).
Neovascularisation of the lens capsule (NVC) is a rare finding theoretically driven by an up-regulation of angiogenic factors such as vascular endothelial growth factor (VEGF) secondary to chronic ischaemia. It may be the solely sign of ischemia in the absence of NVI or NVA especially when the fundus examination is inaccessible. Few cases were reported and emphezised that one should perform a complete clinical evaluation and workup for diagnosis of aetiologies of anterior segment neovascularisation before considering NVC an isolated finding.

To our knowledge, this is the first reported case of NVC associated with proliferative diabetic retinopathy. Neovascularisation spared the iris and the angle. Thus, NVC was the solely sign of anterior segment neovascularisation.
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P021
POSTERIOR SUBLUXATION OF CRYSTALLINE LENS FOLLOWING CATARACT COUCHING: A CASE REPORT
Meriem Elakhdari
Cataract
Meriem
meriem
ELAKHDARI
Morocco
The aim of our presentation is to reveal the risks and the complications of cataract couching as a traditional archaic practice which is rare but still existing in several countries.
Couching is the oldest recorded form of cataract surgery, still performed in several areas of the world. This technique involves the manual dislocation of the crystalline lens into the vitreous cavity, without anesthesia or asepsis conditions, its complications are serious and are represented mainly by glaucoma, retinal detachment and endophthalmitis, with a risk of evisceration.
We report a case of a 63 year old man living in a rural area with a history of cataract couching 2 months ago in his left eye, causing a pain and a decrease in visual acuity.
The clinical examination finds visual acuity radiuses to 1/20, with posterior subluxation of the crystalline lens, without sign of inflammation, ocular hypertonia or retinal detachment.
The patient has benefited from cataract extraction and pars plana vitrectomy, and a retro-pupillary iris-claw lens was implanted. A final best corrected visual acuity of 10/10 was achieved.
Cataract couching is an archaic traditional technique with a high rate of complications, like dislocation of the crystalline lens described in our case. Fortunately, the outcome after surgery for our patient was satisfactory.
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P022
ISTENT INJECT FOR PATIENTS WITH PRIMARY OPEN ANGLE GLAUCOMA (POAG) COMBINED WITH CATARACT SURGERY: RESULTS FROM A RETROSPECTIVE UK CASE SERIES
Mohamed Gamal Elghobaier
Cataract
Mohamed
Gamal
Elghobaier
United Kingdom
To evaluate the efficacy and safety of the iStent inject in patients with POAG combined with cataract surgery.
Ophthalmology department, Colchester hospital, UK
A retrospective, uncontrolled, interventional case series. Fifty six eyes with primary open-angle glaucoma were reported. All subjects underwent ab interno implantation of 2 iStent inject implants together with cataract surgery.
Surgical procedures done by three experienced glaucoma consultants.
Patients were assessed at postoperative week 1, months 1 and 3, and quarterly, thereafter. Data collected included visual acuity, intraocular pressure (using Goldmann tonometry), number of postoperative glaucoma medications, and possible complications.
Fifty six eyes of POAG treated with iStent combined with cataract surgery during the period from January 2020 to November 2020. The minimum follow up period was 3 months and the maximum period was 10 months ( average 8.8± 3 month). The mean visual acuity was 0.51± 1 logMAR at baseline that improved to 0.21±2 at the end of postoperative follow up period of each patient. Twenty five patients (44.6 %) achieved reduction of their intraocular pressure with average reduction of 4.1±1 mmHg (p=0,00001). Twenty patients (35.7) remained unchanged , while 11 patients (19.6) got IOP elevation in comparison with their preoperative baseline IOP. The mean number of preoperative glaucoma drops was 2.1±3 which decreased by 0.94±3 ( p=0.000004). Three patients developed early post operative hyphema ( 2 microscopic hyphema and 1 macroscopic hyphema); all were controlled well medically.
The iStent inject proved to be a safe and effective treatment for patients with POAG combined with cataract surgery. Insertion resulted in a significant decrease in intraocular pressure as well as the number of topical antiglaucoma medications. Few cases reported of manageable postoperative complications.
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P023
INFLUENCE OF AN OPTICAL BIOMETER REPEATABILITY IN THE PREDICTION ERROR ACHIEVED WITH A THICK LENS FORMULA
Joaquín Fernández
Cataract
Joaquín

Fernández
Spain
Influence of an optical biometer repeatability in the prediction error achieved with a thick lens formula
Qvision, Ophthalmology Department, Vithas Virgen del Mar Hospital, AlmerÍa, Spain
A literature search was conducted to identify repeatability studies of the IOL Master 700 (Carl Zeiss AG) optical biometer reporting within-subject standard deviation (Sw). The mean corneal keratometry (Km), anterior chamber depth (ACD), axial length (AXL), lens thickness (LT), central corneal thickness (CCT) and white-to-white (WTW) of the population was estimated from the results reported by each study sample. Two set of random measurements normally distributed with a standard deviation of Sw were generated for all the variables and these were introduced in a thick lens formula to evaluate the prediction error (PE) attributed to measurement bias.
14 studies accomplished the inclusion criteria. Estimated population repeatability coefficients (R=2.77xSw) derived from the 14 studies were 0.25 D for Km and 0.04, 0.05, 0.07, 0.007, and 0.29 mm for ACD, AXL, LT, CCT and WTW, respectively. The R for the PE combining all parameters was 0.29 D [95%CI: 0.24 – 0.34] and the R for the PE attributed to each isolated parameter considered by the formula were 0.24 D [95%CI: 0.21-0.28], 0.03 [95%CI: 0.02-0.04] D and 0.13 [95%CI: 0.07-0.19] D for Km, ACD and AXL.
The biometer resulted in a very good repeatability with up to 95% of eyes achieving a PE attributed to device repeatability below 0.29 D. For a thick lens formula, which predicted the ELP based on ACD and AXL, the Km first and followed by AXL, explained the major part of the PE. The influence of ACD repeatability on PE was negligible. This work demonstrates that even though with a perfect formula,>95% of eyes could result in a PE in +/- 0.50 D but never in +/- 0.25 D due to biometer repeatability.
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P024
CORNEAL ASTIGMATISM DISTRIBUTION IN CATARACT SURGERY CANDIDATES IN A HOSPITAL IN BARCELONA
Jordi Folch Ramos
Cataract
Jordi

folch ramos
Spain
To measure and analyze corneal astigmatism in 1000 consecutive cataract surgeries in a hospital in Barcelona
Germanes Hospitalàries del Sagrat Cor de Jesus 'Hospital Sant Rafael', Barcelona
Refractive and keratometric data of 1000 eyes of 624 patients operated consecutively in the last 6 months for cataracts were retrospectively analyzed -after excluding all those cases with corneal pathology that could alter the baseline values, and also those whose data could be less reliable-.
A descriptive statistical analysis was carried out in order to determine the type, degree and distribution of corneal astigmatism in these patients.

Mean age of the 624 patients was 76.5 ± 7.3 years (range 45 to 98), with more women than men (61.38%).
Mean keratometric value and corneal astigmatism was 44 ± 1.55 D (38.875 to 48.25) and 0.91 ± 0.61 D (0 to 4.5) respectively.
Corneal astigmatism was less than 0.5 D in 14.59% of eyes, but greater than 1 D in 41.97% of the cases (> 2 D in 7.95% and>3 D in 1.28, with no cases greater than 4.5 in our sample). Corneal astigmatism was with the rule (WTR) in 27.83% of cases and against the rule (ATR) in 54.03% (oblique in 18.14%), observing a change with age from WTR to ATR.
Mean corneal astigmatism of our sample was 0.91 ± 0.61 D, being in 27.83% of the cases WTR, 54.03 ATR and 18.14 oblique; these results are very similar to those reported in other studies in populations very different from ours, but a bit different in respect to others with similar population.
There is also a coincidence in the observation that there is a change in the axis of astigmatism from WTR to ATR with the age.
Cataract surgery is one of the most widespread surgical techniques in the world, becoming practically a refractive surgery in recent years. In this order, treatment of astigmatism in these patients is a key point to obtain satisfactory results, and so it is mandatory to know the population that we are going to treat; in our case, 41.7 % of the patients had more than 1 D of corneal astigmatism.
These data can therefore be of interest for both the industry and health providers.

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P025
EVALUATION OF COLLAGEN CROSS LINKING IN KERATOCONUS EYES WITH KERA INTRACORNEAL RING IMPLANTATION
Asaad A. Ghanem
Cataract
Asaad
A.
Ghanem
Egypt
To assess the outcome of collagen cross-linking (CXL) in keratoconus eyes after implantation of Kera intracorneal ring segments.

Mansoura Ophthalmic Center, Mansoura University, Egypt.
twenty one eyes of 13 patients suffering from mild to moderate degree of Keratoconus were included in this study. All eyes had uneventful surgery for Kera intracorneal ring segment implantation followed by collagen cross-linking (CXL) treatment after at least 3 months of the implantation. Inclusion criteria were absence of corneal scarring and corneal thickness higher than 400 mm. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent and cylinder refraction, and the mean keratometric (K) values were evaluated pre and postoperatively.
The mean age was 21.36 ± 4.46 ( range 16- 28 ) years. Mean time between implantation of Kera ring and CXL was 4.56 ± 3.2 months. The mean Baseline UCVA and BCVA were 0.05 ± 0.02 and 0.18 ± 0.1 respectively; after kera ring, the mean UCVA and BCVA were 0.23±0.17 and 0.39 ±0.18 (p =0.000 ) respectively. CXL after Kera ring resulted in an additional change in UCVA and BCVA to become 0.23±0.17 (p=0.951) and 0.41 ±0.18 (p =0.08 ) respectively. Also , CXL results in an additional change in spherical equivalent, cylindrical and the mean keratometric values. The decrease in spherical equivalent , cylindrical and mean keratometric value was 2.8diopters (D) (p<0.05) , 2.1 D (P< 0.05) and 2.5 D (P< 0.05) respectively after Kera ring treatment. An additional decrease of 0.11 D (P> 0.05) , 0.01 D (P> 0.05) and 0.09 D (P> 0.05) was obtained after CXL in each respective parameter
Collagen cross-linking has an additive effect after kera ring implantation and may be considered as an enhancement/stabilizing procedure
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P026
PHACOEMULSIFICATION OF UVEAL CATARACT WITH FEMTOSECOND ASSISTANCE.
Igor Panov
Cataract
Maxim

Grishchenko
Russian Federation
To reduce the time and power of ultrasound influence during femtosecond laser-assisted cataract surgery.
The S.Fyodorov Eye Microsurgery Federal State Institution, the Krasnodar Branch, Russia.
5 patients aged 34 -59 years were operated on. Men – 3, women – 2. 2. In all patients - uveal cataract, plane posterior synechiae, anteroposterior axis 15.39 mm - 23.83 mm, anterior chamber depth 2.46 ± 0.46 mm, lens thickness - 4.05 ± 0.15 mm. Operation technique: after performing a valve incision, we divide the posterior synechiae and perform pupil stretching, install the 'Malyugin ring' retractor. The next stage is femtoassistance, during which capsulorhexis with a diameter of 5.1 mm is performed, that is the prevention of the of posterior synechiae formation in the postoperative period and the dissection of the cataract nucleus into segments convenient for aspiration. After polishing the capsular bag, we implant the IOL without removing the retractor ring into the capsular bag.
Postoperatively visual acuity of 0.3 - 0.6 was determined in 4 patients (80%), in 1 (20%) below 0.3 is explained by concomitant pathology. In 6 months the posterior corneal epithelium cell loss comprised less than 4%. No intraoperative and postoperative complications were noted.
Femtosecond assistance of ultrasound phacoemulsification with IOL of uveal cataract let significantly lower the power and time of ultrasound exposure, which reduces the possibility of development of ultrasound multiple scattering and acoustic shock, and use the positive effect of the IR laser with a wavelength of 720-1200 nm to provide a therapeutic anti-inflammatory effect and normalize the functions of the eyeball structures.
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P027
LENTICULAR CHANGES IN IDIOPATHIC HYPOPARATHYROIDISM
Yogita Gupta
Cataract
Yogita

Gupta
India
To evaluate the lenticular changes in IH and correlate them to clinical and biochemical parameters in cases of idiopathic hypoparathyroidism (IH).
Tertiary care centre
Cross sectional observational case series including diagnosed cases of IH aged ≥ 18 years was performed. Dysfunctional lens index (DLI), internal higher order aberrations (HOA) were calculated using ray tracing aberrometer. Best corrected visual acuity (BCVA), lens opacity grade as per Lens Opacity Classification System (LOCS) III classification and high resolution slit lamp photograph were recorded for each participant. Their correlations with serum total calcium (Ca), inorganic phosphorus (P) and parathormone (PTH) levels were assessed.
30 eyes from 15 IH patients with mean age of 39.93±15.33 years (range,19-64) were included. The mean Ca and P serum levels at the time of examination were 8.04±0.91 and 5.25±0.83 mg/dL, respectively. 26 eyes had mild stellate anterior and posterior subcapsular and capsular opacities, while 4 had mild cortical cataract. The mean DLI and HOAs were 6.03±3.35 and 1.14±1.82 µm, respectively. DLI correlated negatively with Ca level at the diagnosis of IH (r2=-0.4, p=0.01) and age (r2=-0.4, p=0.006), but not with P (p=0.4) or PTH (p=0.8). No significant correlation for HOA was found.
Lenticular changes in IH correlate well with clinical and biochemical parameters. Early lenticular changes in IH were described.
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P028
BILATERAL CONGENITAL ANIRIDIA ASSOCIATED WITH CATARACTS: A CASE REPORT
Zeinebou H’Meimett
Cataract
Zeinebou

H’meimett
Morocco
Congenital aniridia with a caratact is a rare association that can compromise the visual prognosis in the short and long term, especially if the diagnosis is late due to amblyopia. This genetic disease, which is accompanied by other ocular and extra-ocular damage, poses as many medical treatment problems, hence the need of a genetic counseling.
Congenital aniridia is a rare condition (1 / 40,000) manifested mainly by hypoplasia of the iris which can be associated with other eye disorders such as cataracts (glaucoma, corneal dystrophy, congenital cataract, ectopia of the lens, macular hypoplasia and optic nerve) and systemics, especially urogenitals.
It's a 15-year-old patient with no particular pathological history. They visited our facility for a decline in bilateral visual acuity and a notice of the parents of a bilateral leukocoria that had been neglected for several years. A complete ophthalmologic examination and ocular ultrasound were performed.
The ophthalmologic examination reveals a bilateral total white cataract with aniridia, a good anterior chamber. Normal eye tone. The rest of the exam cannot be accessed. The general check-up of this family does not show any extraocular abnormality. The ocular ultrasound was normal. Surgical management of cataracts with scleral implantation in the posterior segment was the treatment of choice. Postoperative amblyotherapy will be an essential complement, hence the benefit of genetic counseling. A post-operative check-up is also necessary to be able to diagnose a complication which requires rapid and effective treatment.
The treatment of cataracts associated with aniridia is difficult, the indication for surgery is to be discussed, and the surgical technique is complex. The visual prognosis is reserved in the long term due to the frequently associated limbic insufficiency.
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P029
POSTERIOR LENTICONUS: WHEN SURGERY IS NOT NECESSARY
Hind Hamdani
Cataract
Hind

Hamdani
Morocco
Posterior lenticonus is a rare progressive disease.
It is a protrusion of the posterior lens capsule and cortex into the vitreous cavity.
It is usually a sporadic unilateral defect but a significant cause of unilateral infantile cataract.
Diagnosis is mainly clinical, difficult in asymptomatic patients, resulting in delayed diagnosis and subsequent amblyopia.
Treatment is usually surgical.
We report in this study the case of a young patient who did not require surgery.
Pediatric ophtalmology department, Hopital 20 Août 1953 Casablanca Morocco
We report the case of a patient with no previous history, who presented with decreased visual acuity in her left eye.
A 10 year child who presented a decreased visual acuity in her left eye consulted at our facility. The ophthalmological examination of the right eye was strictly normal with a corrected visual acuity of 10/10. The examination of the left eye showed a corrected visual acuity of 3/10 with a posterior lenticonus and a slight capsular opacification which was not troublesome. The fundus was normal. The patient benefited from an optical correction under cycloplegia with total occlusion of the right eye for 18 weeks. The final visual acuity was 8/10 in the left eye, and 10/10 on the right eye.
In the case of a posterior lenticonus or any unilateral partial cataract, medical treatment should be attempted.
Once undertaken, close monitoring is necessary due to the risk of frequent relapse.
If the medical treatment fails, surgery should be considered.
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P030
PREDICTING SPHERICAL EQUIVALENT OF PRIOR LASIK ABLATION FROM CORNEAL PACHYMETRY
Arthur Hammer
Cataract
Arthur

HAMMER
United Kingdom
To provide a metric to differentiate between hyperopic and myopic ablation of a prior LASIK treatment based on the corneal pachymetry profile after laser vision correction.
Private Practice (OCL-Vision)
Pachymetry data was recovered from patients who had previous LASIK for refractive purposes between 2019 and 2020. Patients with any corneal disorder were excluded. Ablation spherical equivalent was predicted from central to semi-peripheral corneal thickness (CPT) ratio, both for values provided by pentacam, and values computed from extracted raw pachymetry data.
Data was analysed for 140 eyes of 73 patients (42% female, mean age 40.9, SD 12.8). CPT-ratio cut-off for distinction between myopic and hyperopic LASIK was 0.86 for pentacam-provided values. Sensitivity and specificity were 0.7 and 0.95, respectively. Accuracy increased with computation of CPT based on extracted raw data. Sensitivity and specificity were 0.87 and 0.99, respectively. There was a marked linear correlation between CPT-ratio and ablation spherical equivalent (R2 = 0.93).
CPT ratio cut-offs can correctly classify hyperopic versus myopic spherical equivalent of previous LASIK ablation. In addition, CPT ratio can be used to predict the height of ablation spherical equivalent. This could prove useful for increased accuracy of intraocular lens (IOL) calculations for patients with no historical data of their prior LASIK surgery at the time of cataract surgery planning.
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P031
POSTOPERATIVE CARE IN CATARACT SURGERY AMONGST IRISH CATARACT SURGEONS
Glynis Hanrahan
Cataract
Glynis

HANRAHAN
Ireland
The purpose of this study is to produce a summary of current trends in postoperative care after cataract surgery amongst cataract surgeons in Ireland. Cataract surgery is a high volume surgery in Ireland and has featured in the top 20 day case procedures performed annually in hospitals. It accounts for 1% of all day case procedures.
This study was carried out in the Republic of Ireland from August 2021- November 2021.
A survey was distributed to all Ophthalmology surgeons currently performing cataract surgery in the Republic of Ireland. This included surgeons performing in both the public and private sector.
Post-operative regimes vary per consultant. This is demonstrated by the different patterns in the use of post op dressings, instructions issued to patients on discharge from the hospital, post-operative prophylactic drop regimes and the timing of the first post-operative visit.
This study highlights that key practices in post cataract surgery care differed significantly amongst cataract surgeons in the Republic of Ireland. One queries if going forward that a standardised practised based on evidenced best methods would be more appropriate to improve standards of care for patients across the state.
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P032
DRY EYE EFFECT ON CATARACT SURGERY OUTCOME
Georges Harb
Cataract
Georges

harb
Lebanon
To assess the outcome of treating dry eye before cataract surgery.
French Hospital of the Levant, Beirut, Lebanon
416 patients, diagnosed with cataract and dry eye were included in the study. This prospective study divided the sample on a 1/1 ratio into 2 groups. The first group received treatment for dry eye with lubricant for 2 weeks prior to the surgery and continued for 1 month after the surgery. The second group didn't receive any particular treatment for dry eye. OSDI, Schirmer test and BUT were assessed 1 week and 1 month after surgery for both groups.
The first group that was treated with lubricant showed significant results compared to the second group. One month post- surgery, BUT lasted 10.25+/-1.87 in the first group and 9.32+/-2.12 (with P=<0.0001) in the second group. The same applies to the Schirmer test, the first group scored 18.87+/-4.45 one month post- surgery whereas the second group scored 15.44+/-3.62 (P=<0.0001). In the OSDI the first group showed better results in comparison with the second group, where the first one scored 21.79+/-3.32 and the second one 23.87+/-4.68 (P=<0.0001). The difference between the two groups was already significant one week after the operation.

Comparing the 3 indexes that were chosen, it can be concluded that there is a significant difference between treating the dry eye prior to the cataract surgery, and neglecting it. The dry eye has an effect both clinically and subjectively.
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P033
ONCE IN A BLUE MOON: UNEXPECTED COMPLICATION OF PHACO SURGERY
Hajar Hnich
Cataract
Hajar

Hnich
Morocco
To report an exceptionnal peroperative complication of cataract surgery through the description of a clinical case.
cataract surgery is now the most common surgical procedure performed in the world, despite ongoing advances in cataract surgical technology, a small number of complication will always exist. opacification of the intra ocular lens is one of the rarest complications that may occur, even exceptionnal when it is acute.
uneventful cataract surgery was performed on the left eye of an 64 year old diabetic man. a foldeble hydrophilic acrylic intraocular lens( IOL, manifactured by: CAREGROUP SIGHT SOLUTION PRIVATE LIMITED) was implanted in the bag. we were just about to seal the incisions, we noticed sudden cloudy IOL. however, the lens was not changed, and the whitish aspect disapeared the following day, and it stayed clear after 6 months follow-up.
the opacification of hydrophilic acrylic IOL is a rare complication usually occurring in the late posteperative period. the exact causes and pathomechanisms leading to opacification is unknown. in our case, under topical anesthesia, the phacoemulsification surgery using the stop and shop technique was uneventful, we used viscoelastic hyaluronate(2%), balanced sel serum and intracameral cefuroxime(1mg/0.1ml). we made sure to investigate the cause of opacification and we found that the IOL was kept in a cold storage making the rapide temperature change a probable mechanism of the acute opacification of the lens.
acute opacification of hydrophilic acrylic lens is a very rare phenomenon, in the light of this presented case, we tend to highlight the importance of appropriate storage of the IOLs to prevent sudden temperature change of the lens during implantation. also, we find that immediate IOL exchange is unecessary as it clears up spontaneously.
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On-demand

P034
COMPARISION OF OCULAR BIOMETRY IN CATARACT PATIENTS USING TWO SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY DEVICES
Vivian Wing Man Ho
Cataract
Vivian
Wing Man
ho
Hong Kong
To compare the ocular biometric measurements between 2 swept-source optical coherence tomography (SS-OCT) devices, IOL Master 700 and ANTERION.
Department of Ophthalmology, United Christian Hospital, Hong Kong

This retrospective study included all cataract patients who had their biometric measurements obtained with the 2 devices ANTERION and IOL master 700, between June and July 2021 at the United christian Hospital, Hong Kong. Patients scheduled for cataract surgery were measured with both SSOCT devices on the same day. The following biometry parameters were compared: keratometry (K), total keratometry (TK), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and axial length (AL). To assess the agreement between the devices, intraclass coefficient (ICC) and Bland-Altman analysis with 95% limits of agreement (LoA) were used.
In total, 104 eyes of 52 subjects were measured with both devices. Average anterior keratometry showed an excellent agreement (ICC ≥ 0.983), and the mean difference was less than 0.1 D. The ICC of the total average keratometry showed excellent agreement (ICC ≥ 0.980) however the mean difference was more than 0.5D. The AL measurement showed excellent agreement (ICC = 0.996), with a mean difference of<0.006 mm. The CCT, ACD, and LT also showed excellent agreement (ICC> 0.9). The ANTERION did not obtain ACD, AL and LT in four cases (3.85%), four cases (3.85%) and seven cases (6.73%) respectively; and IOL master did not obtain ACD, AL and LT in two (1.92%) cases, respectively.
The SS-OCT based device ANTERION showed a good agreement with IOL master 700 in most biometric measurement except for total keratometry. It also has a greater failure rate in obtaining LT measurement. Although there is a good agreement with most of the biometry parameters, the devices should not be used interchangeably.
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P035
AXIAL LENGTH CHANGE BETWEEN BEFORE AND AFTER CATARACT SURGERY
David Peter Johler
Cataract
David
Peter
Johler
Austria
To achieve the desired post-operative refraction after cataract surgery, exact preoperative biometry is necessary. Precise measurement of axial length (AL) is critical for proper IOL calculation. Therefore, postoperative AL changes may have an impact on the final refraction. Recent studies found a decrease in axial length with cataract surgery. The study investigated pre- and postoperative biometric data assessed with two optical biometers (IOLMaster 700 and ANTERION).
Vienna Institute for Research in Ocular Surgery (VIROS), a Karl-Landsteiner Institute, Hanusch Hospital, Vienna.
Patients scheduled for cataract surgery between March and October 2020 were included in the present study. Fifty eyes of 50 patients (19 males) were selected and 36 patients completed the study. Before surgery of the eye, patients underwent a complete ophthalmic examination, including IOLMaster 700 and ANTERION biometry as well as LOCS grading of cataract intensity. Biometry was repeated three months after surgery.
A statistically significant, but comparable, AL reduction after cataract surgery of 0.08 ± 0.04 mm and 0.07 ± 0.07 mm was found with the IOLMaster 700 and the ANTERION, respectively. Difference in keratometry was comparable between both devices (-0.02 ± 0.24 D with IOLMaster and -0.09 ± 0.24 D with ANTERION). There was no correlation between lens thickness or keratometry and the reduction of AL. However, a statistically significant correlation was found for cataract grade (total LOCS score and nuclear LOCS score) and the change in measured AL.
The study showed a shorter axial length after cataract surgery using two modern biometers, comparable to previous published data. The comparison between the devices showed good agreement in AL measurements and keratometry. Lens thickness as well as pre- and postoperative anterior chamber depth were slightly lager using the ANTERION. The grade of cataract seems to have a slight impact on the change in AL values measured.
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On-demand

P036
INTRASTROMAL AIR INJECTION VERSUS HYDRATION FOR WOUND SEALING IN PHACOEMULSIFICATION
Reham Fattoh Ahmed Khalil
Cataract
Reham
Fattoh Ahmed
Khalil
Egypt
To determine safety and efficacy of intrastromal air injection for wound sealing in phacoemulsification.
To compare between this novel technique and conventional intrastromal hydration as regards safety and efficacy.
Sohag Ophthalmology Hospital, Sohag, Egypt
100 eyes of 100 patients with age-related cataract were included. They were divided randomly into two groups: group A; intrastromal hydration technique was used, and group B; intrastromal air injection was used. Both groups were matched for age and lens opacity grade(LOGS).
All eyes underwent unevenfull phacoemulsification with IOL implantation.
Comparative outcomes one month postoperatively: wound sealing and healing (anterior segment OCT), endothelial cell count and morphology (specular microscopy), postoperative complications, corrected distance visual acuity (CDVA).
There was statistically insignificant difference between both groups as regards age, LOGS, baseline endothelial study.
No cases of postoperative complications were reported.
Perfect wound sealing detected early postoperative and healing by primary intension occurred as detected by anterior segement OCT one month postoperatively.
The difference in CDVA and postoperative endothelial study at one month was statistically insignificant between both groups.

Intrastromal air injection is a safe and as effective technique as intrastromal hydration for wound sealing during phacoemulsification
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On-demand

P037
STEPWISE GROOVING TECHNIQUE IN HARD CATARACT
Reham Fattoh Ahmed Khalil
Cataract
Reham
Fattoh Ahmed
Khalil
Egypt
To evaluate the safety and efficacy of a new stepwise grooving technique in hard cataract.
Sohag Ophthalmology Hospital, Sohag, Egypt
20 eyes of 20 patients aged 60-80 years old with hard cataract (Grade III and IV; lens opacity classification system(LOCS)) underwent phacoemulsification. Stepwise grooving technique entailed initial grooving of the nucleus in stepwise configuration (two parallel vertical grooves and a connecting horizontal groove in between). After deepening; the nucleus could be separated into two halves by placing the chopper and phacoprobe in the corresponding right angles created between the vertical and horizontal grooves. Outcome measures included BCVA, Specular changes, Corneal edema, US power used, intraoperative and postoperative complications.
This was a prospective interventional study. BCVA one month postoperatively ranged from 0.5-0.2 in LogMAR, average 0.25. Fifteen eyes showed clear cornea from the second postoperative day. Five eyes had mild corneal edema resolved by conservative treatment within two weeks. Comparison with nearly matched group which underwent conventional divide and conquer technique revealed that there were statistically insignificant difference between both groups as regards BCVA, endothelial changes, intraoperative and postoperative complications.
Stepwise grooving as a novel technique is a safe and as effective as conventional divide and conquer technique in hard cataract.
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On-demand

P038
NON-DIFFRACTIVE WAVEFRONT SHAPING EXTENDED DEPTH OF FOCUS (EDOF) INTRAOCULAR LENS: VISUAL PERFORMANCE AND PATIENT-REPORTED OUTCOME
Thomas Kohnen
Cataract
Thomas

KOHNEN
Germany
To evaluate visual performance and patient-reported outcomes after bilateral implantation of new non-diffractive wavefront shaping extended depth of focus (EDOF) intraocular lens (IOL).
Department of Ophthalmology, Goethe University, Frankfurt, Germany.
Patient population: We included 16 patients (32 eyes) who received bilateral implantation of a non-diffractive wavefront shaping EDOF IOL (AcrySof® IQ Vivity®, Alcon Research, TX, USA). Target refraction in both eyes was emmetropia.
Observation procedure: Monocular and binocular uncorrected (UCVA) and distance-corrected (DCVA) visual acuity (VA), refractive outcome, defocus curve, contrast sensitivity (CS) were evaluated 3 months after surgery with a questionnaire on optical phenomena and spectacle independence.
Main Outcome measure: Three months postoperative monocular and binocular UCVA and DCVA (logMAR); defocus curve; CS; and quality of vision (QoV) questionnaire results.
Mean spherical equivalent was -0.16 ± 0.37 D 3 month postoperatively. Binocular UDVA at distance, intermediate, and near was 0.01 ± 0.05 logMAR at 4m, 0.05 ± 0.05 logMAR at 80cm, 0.07 ± 0.06 logMAR at 66cm, and 0.25 ± 0.11 logMAR at 40cm, respectively. Despite some minor optical phenomena, 88% of patients would choose the same lens. 63% of patients reported no optical phenomena at all. Contrast sensitivity was 1.25 ± 0.41 logCS (photopic), 0.96 ± 0.24 logCS (mesopic) and 0.93 ± 0.24 (mesopic + glare).
This non-diffractive wavefront shaping EDOF IOL provides good VA at far and intermediate distance and functional near VA. It showed good QoV and CS, and high spectacle independence for distance and intermediate vision with significantly less optical phenomena than with other EDOF or MIOLs.
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On-demand

P039
EFFECT OF INTRAOCULAR LENS IMPLANTATION DURING SURGERY ON EARLY INTRAOCULAR PRESSURE CHANGES IN NUCLEUS DROP CASES
Safak Korkmaz
Cataract
Safak

Korkmaz
Turkey
To evaluate the effect of implantation of a 3-piece foldable posterior chamber intraocular lens (IOL) into the ciliary sulcus during phacoemulsification surgery on early intraocular pressure (IOP) changes in patients with nuclear drop.
Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Ophthalmology
Twenty-two eyes of 22 patients whose surgery were complicated with nucleus drop during phacoemulsification were included in the study. 12 patients had a 3-piece posterior chamber IOL implantation simultaneously with cataract surgery (Pseudophakic group), and 10 patients were aphakic in the first session (Aphakic group). To evaluate early postoperative IOP changes, patients who underwent pars plana vitrectomy (PPV) surgery 7 days after cataract surgery were included in the study. IOP was evaluated retrospectively until the patients underwent to PPV surgery. Corneal edema with IOP of 40 mmHg and above was considered as a sudden increase in IOP and was treated with intravenous mannitol in addition to topical antiglaucoma treatment.
Preoperative mean IOP was significantly higher in the aphakic group compared to the pseudophakic group (23.6±5.3; range 17-34 mm Hg vs. 18±4.4; range 14-26 mm Hg) (p=0.016; t-test). The rate of preoperative use of at least one antiglaucomatous drug was higher in the Aphakic group (8/10, 80% vs 3/12, 25%) (p=0.01, Chi-square test). A sudden increase in IOP was observed on the 2nd and 6th days after cataract surgery. The sudden increase in IOP was statistically significantly higher in the aphakic group compared to the pseudophakic group (6/10, 60% vs 2/12, 20%) (p=0.035).
In nucleus drop cases, 3-piece IOL implantation in the same session reduces IOP spikes and the need for preoperative antiglaucoma medication. In aphakic patients, sudden IOP elevations can be seen due to the inflammation effect of the cortex remnants that could pass into the anterior chamber due to the lack of barrier and these particles may occlude both trabeculum and the Schlemm canal. This may also affect the final visual acuity.
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On-demand

P040
EFFECT OF TEAR OSMOLARITY ON POSTOPERATIVE REFRACTIVE ERROR AFTER CATARACT SURGERY
Anete Kursite
Cataract
Anete

KURSITE
Latvia
To analyze effects of tear osmolarity on postoperative refractive error in patients undergoing cataract surgery.
One Clinical University Hospital
Prospective study. Patients were divided in two groups based on tear osmolarity (group Nr 1- normal tear osmolarity,<310 mosm/L; group Nr 2- hyperosmolar,>310 mosm/L). Exclusion criteria were met to avoid the effects of other factors that could significantly affect visual acuity and/or refraction (preoperative refractive error (>3 D), corneal pathologies, long or short axial length, uncontrolled and uncompensated ophthalmological co-morbidities). Preoperative and postoperative (1 month after surgery) visual acuity (VA), refraction and best corrected visual acuity (BCVA) was measured. Postoperative refractive error was measured as spherical equivalent (SE = sph + (0.5 × cyl)). Post operative VA, BCVA and SE were compared between groups.
In the study were included 60 patients, who were scheduled for standard cataract surgery. 30 patients in group Nr 1 (control group, normal tear osmolarity) and 30 patients in group Nr 2 (hyperosmolar group). Targeted refraction for all patients after surgery was plano (0 D). Hyperosmolar group had statistically significant higher postoperative refractive error (p=0.01, Avarage SE Group 1= 0,345; Group 2= 0,608) and lower VA after surgery (p=0.02, Avarage VA Group 1= 0,896; Group 2= 0,832). But there was no statistically significant difference in BCVA after surgery between groups (p=0.16).
Increased tear osmolarity can significantly affect planned outcome of the cataract surgery as an unexpected refractive error. It would be useful to measure tear osmolarity before cataract surgery to achieve accurate results and improve patient satisfaction after surgery.
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On-demand

P041
NEW LENS EXTRACTION DEVICE FOR LOW ENERGY CATARACT FRAGMENTATION
Barbara Kusa
Cataract
Barbara

Kusa
Italy
The new miLOOP (Carl Zeiss Meditec)is a micro interventional device designed to delivery low energy endocapsular lens fragmentation manly in dense cataract and complicated cases Single use device, finger controlled, no phaco energy no cavitation reduced I/A. Every cataract extraction is based on the needs to divide the nucleus.
Piovella Global Center for Ophthalmology, Monza, Italy
miLOOP was adopted 188 Eyes of 116 patients with medium/hard cataract to split the nucleus in two part or more.The metal loop was inserted in the capsular bag and open throught the edge of idrodelineation rime. Once the loop is in the proper vertical position the loop is retracted ti split the nucleus
The nucleus was split in two or more pieces in all patirents. It is necessary a learning curve adotping the device in simple cases to be confident in the proper use to avoid device related complications In one case the loop did not match the capsular bag and coused mild zonula damage with no significant weak event. In one eye we experienced opening of the posterior capsule due to a lock of experience in adopting the device that was opened and retracted more then one single time
miLOOP adoption in medium dense cataract and in complicated cases riduces phaco energy by 50%, reduces I/A fluid use by 30 % and makes hard nucleus cataract removal more controlled and efficient. A proper learning curve needed.
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P042
PRECISION PULSE CAPSULOTOMY TO PERFORM CAPSULORHEXIS WITH AN AUTOMATED METHOD WITH SUPERIOR OUTCOMES AND DECREASED COMPLICATIONS RATE
Barbara Kusa
Cataract
Barbara

Kusa
Italy
Radial tears in the capsulorhexis increase the rate surgical complications.Zepto precision pulse capsulotomy (PPC) technology (Mynosys - Fremont, California) is compared with manual continuous curvilinear capsulorhexis (CCC) outcomes by the reproducibility, uniformity, circularity, diameter size and complications rate.
Piovella Global Center for Ophthalmology, Monza, Italy
Methods:A novel capsulotomy method and technology called PPC and trade named Zepto was adopted on 457 consecutive eyes with cataract
The ACD was 2.69 ± 0.43. ECC preop was 2365 ± 360 and 1 year postop 2214 ± 53 with a 2.46 % lost cells. We experienced 17 anterior radial tears during a difficult learning curve
The Zepto PPC technology creates a precise circular anterior capsulotomy. This technique allows cataract surgeons to reduce the rate of capsulorhexis and cataract surgery complications. Really helpfull for white mature cataract and small pupils
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P043
PATIENT SATISFACTION AND ATTITUDES TOWARDS IMMEDIATE SEQUENTIAL BILATERAL CATARACT SURGERY: A QUALITATIVE STUDY USING THEMATIC ANALYSIS
Chuiki Jasmine La
Cataract
Chuiki
Jasmine
La
United Kingdom
To investigate the experiences of patients undergoing immediate sequential bilateral cataract surgery (ISBCS) in the public sector.
Royal Bournemouth Hospital Eye Unit, University Hospitals Dorset (UK National Health Service)
Consecutive patients undergoing ISBCS supervised by a single surgeon over a one-year period were identified. Cases were excluded if they involved general anaesthesia, were performed within the private sector, or were unable to be contacted. All eyes met the local NHS criteria for cataract surgery based on visual acuity and / or vision-related quality of life. At least four weeks postoperatively, semi-structured interviews were conducted by an independent interviewer to explore the patient's experiences peri- and post-operatively. Qualitative analysis of the responses was performed, alongside an assessment of postoperative function using a Modified Barthel Activity of Daily Living Score.
25 patients were included. Most had both eyes treated by the same surgeon, with 16% having a different surgeon for their second eye. The most frequent reason for choosing ISBCS was the convenience of a single visit to hospital (88%), with 20% specifically citing coronavirus as a reason for wanting to limit exposure to a healthcare environment. All patients were happy to proceed with their second eye after surgery on the first eye was complete. All patients were satisfied postoperatively, with 96% saying they would recommend ISBCS to friends and family. Minimal reductions in function were reported in the early postoperative period. Preoperative concerns regarding the idea of ISBCS that require additional counselling included: fear of no vision bilaterally due to padding after surgery; fear of bilateral complications; lack of familiarity with ISBCS among friends and family. Differences in the second eye experience were raised as a concern when a different surgeon treated each eye.
In appropriately selected and counselled patients, ISBCS results in high levels of patient satisfaction. Written information regarding the common themes of concern identified in this study can assist preoperative counselling and potentially increase uptake. When different surgeons are treating each eye, both should be of similar ability and adopt a standardised surgical approach.
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P044
SAVING A CHILD FROM SCHOOL DROPPING OUT. A RARE CASE OF BILATERAL MICROSPHEROPHAKIA
Zyad Laftimi
Cataract
Zyad

laftimi
Morocco
To asses the outcome of the intra lenticular lens aspiration in microspherophakia for a paediatric case.
The patient were seen in a medical campaign in Atlas region of Africa and got transfered urgently to 20 Aout University Hospital, where could a complete examination were done in paediatric ophtalmology departement.
The study is about a signe case report of a 12 years old child whose both parents suffers from intellectual disability, schooled and a newly dropped out. The patient suffers from low visual acuity since birth and couldn't benefit from an ophtalmological examination.
The initial examination results were, a visual acuity at 1/10 in both eyes without a target at refraction, the IOP was normal at 10 mmHg. We noticed a subluxed lens inferiorly and nasaly in the right eye, but posteriourly in the left eye. The zonula fibers were abnormaly ellongated in both eyes. There was no anomaly in posteriour segment. After tropicamid dilatation, the lens got luxed anteriourly having an athalamia. there was no complication, endothelium cells were fine abd there wasn't an angle closure glaucoma. The surgical managment was phaco aspiration with anteriour vitrectomy. Aphakia glasses were prescribed with 10/10 acuity bilaterally. There was no marfan or marchesani syndrome.
We believe that clear lens extraction and IOL implantation may be a valid treatment option for high myopia in cases of microspherophakia, but lens dislocation with abnormal zonular fibers, promiscuity and low social development of the child's family couldn't permit the implantation nor prescribtion of contact lenses.
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P045
SUCCESSFUL MANAGEMENT OF DESCEMET DETACHMENT DUE TO HYDROSEPARATION DURING PHACOEMULSIFICATION
Miguel Leitão
Cataract
Miguel

LEITÃO
Portugal
To describe a case of successful management of huge Descemet's Membrane Detachment (DMD) during hydration of phacoemulsification main port.
Case-report study from Instituto de Oftalmologia Dr. Gama Pinto
A 66 year-old male patient underwent cataract surgery using phacoemulsification on his right eye (RE) at Instituto de Oftalmologia Dr. Gama Pinto. There was no prior systemic or ophthalmic conditions. On preop evaluation, Best Corrected Visual Acuity (BCVA) was counting fingers on his RE and 20/1000 on his left eye (LE). Intraocular pressure (IOP) was 14 and 15 mmHg for the RE and LE, respectively. On slit lamp examination, there was an apparent corneal arcus senilis, formed anterior chamber, pseudoexfoliation and dense white cataracts on both eyes. No fundus examination was possible due to significant media opacities. Ultrasound imaging revealed no vitreoretinal abnormalities, namely retinal detachment. During examination, patient collaboration was very poor, hence a peribulbar anesthesia was planned.
Cataract surgery was performed uneventfully, the surgeon using triplanar corneal incision, viscoelastic soft-shell technique, direct chop, with good centration of the monofocal IOL. Upon phaco main port hydration, occured a sudden patient head movement, causing a BSS fluid wave to travel between the corneal stroma and Descemet's Membrane (DM), thereby resulting in a central rhegmatogenous DMD with 1/2 of corneal total area and subsequent loss of corneal transparency. Gentle hydration of the side borders of the main port and a transcorneal suture were then performed and an air bubble was injected in the anterior chamber, enough to encompass the whole DMD. After 5 minutes, the cornea regained its transparency, the eye was then patched, the patient was in supine position for 1 hour and instructed to do so at home in the first day of post op.
On post-op day one, patient had no complaints, BCVA was 20/100, IOP was 18 mmHg, the cornea was transparent and the DM was reattached, confirmed by Anterior Segment OCT (AS-OCT). One month after the surgery, BCVA was 20/30, with corneal transparency and apposition of DM.
DMD is a potentially vision-threatening complication of cataract surgery, rare in the intraoperative and common in the postoperative period. Major risk factors include advanced age, pre-existing corneal endothelial disease, hard cataract, prolonged surgical time, ragged clear corneal incisions and inadvertent trauma. Large, central DMD's if not managed appropriately, may lead to corneal decompensation and opacification. AS-OCT can be useful for diagnosis, treatment planning and prognosis of such cases. Descemetopexy is the mainstay of treatment, with re-apposition in 71-87.5% of cases). Our case report highlights the importance of immediate recognition of intraoperative DMD and proper treatment, preventing surgical reintervention or irreversible corneal opacification.
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P046
SHORT EYES: INTRAOCULAR LENS POWER FORMULA ACCURACY - COMPARISON OF 14 FORMULAS
Diogo Maleita
Cataract
Diogo

Maleita
Portugal
The aim of this study is to compare the accuracy of 14 IOL power formulas predicting refractive error in short eyes (AL ≤ 22.0mm).
Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
Retrospective case-series, including patients submitted to uneventful age-related cataract surgery over the last 5 years with a single spherical monofocal IOL model implantation. Preoperative biometric data were obtained through LenStar 900. Using optimized constants for the whole range of AL, refraction prediction errors was calculated for: Barret Universal II (BUII), Castrop, Cooke K4, Emmetropia Verifying Optical (EVO 2.0), Haigis, HofferQ, Holladay 1, Kane, Naeser 2, Olsen, SRK/T, T2, VRF and VRF-G. Mean prediction error (PE) and its standard deviation (SD), the median absolute error (MedAE), the mean absolute error (MAE) and the percentages of eyes with PE within ±0.25, ±0.50 and ±1.00 diopters (D) were evaluated.
A total of 318 eyes from 318 patients were included. Mean axial length was 21.61 ± 0.35mm (range 20.40 - 21.99mm). Analysis of the absolute PE revealed statistically significant differences (p< 0.001) between the formulas analyzed. The lowest absolute errors were obtained with VRF-G, Kane, Olsen and Cooke K4 formulas. There was also a statistically significant difference between percentages of eyes within ±0.50D (p<0.001). The only formula obtaining a percentage of eyes within ±0.50D>75% was the Kane formula (75.2%).
New generation formulas, particularly VRF-G, Kane, Olsen and Cooke K4 formulas, seem to be reliable and accurate in eyes with AL ≤ 22.0mm.
Eposter
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On-demand

P047
SURGICAL APPROACH IN PHACOMORPHIC GLAUCOMA
Cerghedean-Florea Maria-Emilia
Cataract
Cerghedean-Florea

MARIA-EMILIA
Romania
Phacomorphic glaucoma is a secondary angle closure glaucoma caused by special forms of advanced cataract, usually associated with increased of the lens volume. In some cases of young adults with high IOP values morphologic changes of the lens could be involved in the pathogenesis of the disease.
ARCADA Clinic Sibiu
Faculty of Medicine, University 'Lucian Blaga' din Sibiu, Romania
We report the management of a case of a 42-year-old woman diagnosed with phacomorphic glaucoma, accidentally discovered after a routine ophthalmological exam.
The ophthalmological exam revealed: RE BCVA - 0.7, LE BCVA – 1, RE IOP - 19 mmHg, LE IOP - 30 mmHg. Both lenses were transparent. Old records revealed the patient to be hypermetropic. Biometry also showed shallow anterior chamber, increased sagittal lens volume and short axial length. We started with hypotensive treatment in both eyes and peripheral laser iridotomy in LE to decrease intraocular pressure, in order to perform the surgery. Phacoemulsification with IOL implantation was performed in both eyes. Postoperative outcome was positive: BCVA – 20/20 in both eyes with normal IOP.
The diagnosis of phacomorphic glaucoma requires special attention especially in cases of transparent lens and without an ophthalmic history , surgical approach remains the only effective treatment in these cases.
Eposter
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On-demand

P048
CLINICAL RESULTS OBTAINED WITH THE NEW PHYSIOL ISOPURE 123: AN ISOFOCAL OPTICAL DESIGN TO ACHIEVE FUNCTIONAL INTERMEDIATE VISION
Aisling brigid Mcglacken-Byrne
Cataract
Aisling
brigid
mcglacken-byrne
Ireland
To evaluate the clinical results obtained with the new PhysIOL Isopure 123: using an isofocal optical design to achieve functional intermediate vision.
Tertiary referral centre in Ireland: The Royal Victoria Eye and Ear Hospital
An observational study of patients with a isofocal IOL (PhysIOL Isopure 123) implanted between December 2020 and October 2021. Visual outcomes were assessed 1 month postoperatively; uncorrected and best-corrected distance visual acuity using logMAR at 4 metres, uncorrected and corrected intermediate (70cm) and reading/near visual acuity using a Jaeger chart
Nineteen eyes of 18 patients were analysed. Mean preoperative distance visual acuity was 0.66 ± 0.71 logMAR. At the one-month post-operative follow-up visit, uncorrected distance visual acuity was 0.17 ± 0.17 logMAR and corrected distance visual acuity was 0.07 ± 0.12 logMAR. Two thirds (66%, n=12) of patients achieved uncorrected intermediate visual acuity (70cm) of N12 or better. Wearing their auto-refraction correction, sixty-six achieved N12 or better at 70cm and over half (53%) could read N10 or better at their comfortable near distance. There were no intra or post-operative complications of note. Mean post-operative spherical equivalent was -0.06 ± 0.04.
The results demonstrated that the PhysIOL Isopure 123 is able to restore near, intermediate, and distance visual function.
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On-demand

P049
RARE INDICATION FOR INTRAOCULAR LENS EXCHANGE
Andrada-Elena Mirescu
Cataract
Andrada-Elena

Mirescu
Romania
The current paper emphasizes on the case of a healthy young adult who was implanted a premium trifocal IOL. Six months later, in spite of the excellent refractive outcome, the patient's vision was not satisfactory. Therefore, the first IOL was exchanged with another premium model, with better visual performance.
A 38 year-old young male underwent cataract surgery and was implanted a ZEISS AT LISA trifocal intraocular lens. 6-months postoperatively, the best corrected visual acuity was 0.4 for both near and far vision, despite the good lens centration and the neglectable residual refraction (minus 0.25 cylinder diopters at 160 degrees).
After excluding any associated ophthalmic condition, considering the possibility of persistent lack of neural adaptation, we proceeded with the IOL exchange. Under viscoelastic protection, the IOL was carefully removed from the capsular bag and extracted from the eye by using the bisection technique. A premium hybrid EDOF IOL (EDEN, Swiss Advanced Vision) was implanted in the bag, with no capsular damage. No anterior or pars plana vitrectomy were needed during the exchange procedure.
Postoperatively, both distance and near best corrected visual acuity significantly improved to 0.8, there was a minor myopic and astigmatic residual refractive error and the patient experienced an overall better quality of vision, with no visual disturbances.
Intraocular lens exchange, an unusual procedure, has specific indications, such as: in-the-bag or out-of-the bag subluxation, intraocular inflammation, selected cases with residual refractive errors, visual disturbances (such as halos and glare) and persistent lack of neural adaptation.
Multifocal IOLs require significant neural adaptation. The lack of it may conduct to unsatisfied patients and further interventions.
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On-demand

P050
DOES THE INNOVATIVE MONOFOCAL INTRAOCULAR LENSES WITH EXTENDED DEPTH OF FOCUS GIVE BENEFITS FOR THE PATIENT? ONE YEAR OBSERVATIONS.
Ewa Mrukwa-Kominek
Cataract
Ewa

Mrukwa-Kominek
Poland
The aim of the study is to present the final results of the implantation of monofocal intraocular lenses with extended depth of focus in cataract patients.
1 Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland
2 Department of Ophthalmology, Professor K. Gibinski University Clinical Center of the Medical University of Silesia, Katowice, Poland
As part of the project, 20 Monofocal IOL with extended depth of focus (TECNIS Eyhance IOL, J&J, USA) were implanted during cataract phacoemulsification to assess the effectiveness of the lens and evaluate the technique of implantation. The power of implanted lenses was calculated by distance emmetropy. Patients were checked prior to surgery and in the follow-up for: Catquest-9SF 2011 questionnaire to assess vision-related quality of life, visual acuity measurements - UDVA, BCDVA, UIVA (66cm), UCNVA and refraction using maximum plus technique. One year after the procedure, patients' visual acuity and level of satisfaction were checked and assessed nagain
Binocular implantation, twenty eyes (10 patients), mean age 63.8. IOL power was from 19.0 to 25.5 D. Mean UCDVA, UCIVA change significantly after the procedure (0.2 to 0.9; 6 to 10 respectively, p<0.05). For near vision patients need glasses correction. The average refractive error before surgery was -1.50 D +/- 2.25 D, postop -0.25 D +/- 0.50 D. No adverse effects were observed. The results of surveys - Catquest-9SF indicate a significant improvement in the performance of daily activities (30% satisfied and 60% very satisfied). Patient satisfaction after one year of follow-up was very high (90%), without eye-related adverse events
The IOL power was from 19.0 to 25.5 D. The mean UCDVA, UCIVA change significantly after the procedure (0.2 to 0.9; 6 to 10 respectively, p<0.05). The average refractive error before surgery was -1.50 D +/- 2.25 D, postop -0.25 D +/- 0.50 D. No adverse effects were observed. The results of surveys - Catquest-9SF indicate a significant improvement in the performance of daily activities. Patient satisfaction after one year of follow-up was very high, they did not report any eye-related adverse events
The innovative monofocal IOL with extended depth of focus -TECNIS Eyhance provides patients very good far-distance vision and improved vision at intermediate distances. Improvement of daily activity related to vision was also much better after binocular implantation. These intraocular lenses seem to achieve optimal results permanently and give benefits for the patients.
Eposter
On-demand
On-demand

P051
A CURIOUS CASE OF CHRONIC CORNEAL OEDEMA
Ritika Mukhija
Cataract
Ritika

Mukhija
United Kingdom
To describe a case of chronic corneal oedema due to retained nuclear fragment after uneventful phacoemulsification misdiagnosed as viral keratitis.
Tertiary care eye hospital
Case report and literature review
An 89-year-old gentleman with multiple episodes of inferior corneal oedema and low-grade anterior segment inflammation over 18 months was diagnosed and managed as viral keratitis; however, the episodes kept recurring every time treatment, vis-à-vis topical steroids, were tapered or stopped. Past ophthalmic history revealed bilateral phacoemulsification surgeries; right eye was operated in 2015 with documentation of intra-operative floppy iris, and mobile iris-lens diaphragm, necessitating suturing of the wounds, and left eye was operated more recently, in 2019, documented as uneventful; however, required laser posterior capsulotomy two months after the surgery. On current ocular examination, he was noted to have inferior corneal oedema with Descemet folds, no visible anterior chamber inflammation, slightly peaked but otherwise central pupil with an area of inferior iris chafing.
History of cataract surgery few months prior to onset of the symptoms, lack of other features of viral keratitis, such as keratic precipitates and inferior corneal oedema in the presence of slight pupillary peaking led to the suspicion of either a retained lens fragment (RLF) or other possible iatrogenic insult. As the view of inferior anterior chamber was limited, we performed anterior-segment optical coherence tomogram (ASOCT) focused on the inferior angle, which revealed a hyper-reflective mass, which was in fact a retained lensfragment in the anterior chamber; this was removed surgically as an emergency procedure. This resulted in significant improvement in the corneal oedema, as well as marked symptomatic relief confirmed by the patient.
Inferior corneal oedema in an eye after cataract surgery should raise the suspicion of a retained lens fragment. Anterior segment OCT helped to clinch the diagnosis and may serve extremely useful in eyes with poor view of the anterior chamber and angle using gonioscopy. Retained lens fragment in anterior chamber after uneventful cataract surgery is uncommon yet an important cause of iatrogenic inflammation and corneal oedema.
Eposter
On-demand
On-demand

P052
CALCULATION OF RISK FACTORS FOR POSTOPERATIVE COMPLICATIONS IN PHACOEMULSIFICATION SURGERY WITH THE AID OF A SOFTWARE APPLICATION
Ioanna Mylona
Cataract
Ioanna

MYLONA
Greece
Recently our research team created a statistically validated system for classifying risk factors for intraoperative complications in phacoemulsification surgery. The purpose of this study is to present a standalone software application for handheld computing devices (mobile phones, tablets) which will classify risk factors for intraoperative complications in phacoemulsification surgery and will indicate overall risk.
Hippokration General Hospital of Thesaaloniki
Describes the operation and use of an application for IOS and Android operating systems. Factors evaluated are: Age<50 or> 85 years, High ametropia> 6 diopters, S / D, glaucoma, previous loss of one eye, previous vitrectomy, small pupil diameter (<2.5 mm), shallow anterior chamber , white cataract, corneal scarring, pseudo-exfoliation, phacoemulsification, deep orbit and poor patient cooperation (eg low hearing, cognitive deficits).
The application is available for free, is standalone and does not require an internet connection. Gives the overall rating of risk factors and categorization into risk groups. It does not store patients' personal data and can export the result to a file.
The application is a useful tool for the clinician who wants to have a direct and valid assessment of the preoperative risk in phacoemulsification surgery.
Eposter
On-demand
On-demand

P054
THE IMPACT OF DECERTATION OF WAVEFRONT-CORRECTING EDOF LENS IN ITS OPTICAL PERFORMANCE, A CASE REPORT
Ali Nowrouzi
Cataract
Ali

NOWROUZI
Spain
To show the relevance of proper centration of the central 2.2 mm optical part of the Vivity EDOF lens in order to achieve a satisfactory vision for both intermediate and near.
Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
A 77-year-old man presented to our clinic for refractive lens exchange surgery in his right eye (CDVA of 20/40, UNVA and UIVA of 20/200) and 20/20 in his left eye.Wavefront-correcting EDOF (X-Wave Technology) was selected to be implanted to achieve acceptable intermediate and near depth of focus. Four weeks postoperatively patient satisfaction was remarkably low for intermediate and near vision although he gained a good UCDVA (UCDVA of 20/25 but UIVA of 20/100, and UNVA (40 cm) of 20/125).
4 mm decentration of central 2.2 mm optical zone shifted to the upper nasal part of the capsular bag was confirmed by the camera of Osiris aberrometer (Osiris, Italy).IOL exchange was planned with aspheric multifocal diffractive IOL (Rayone , Rayner, USA). One week postoperativelythe patient gained acceptable intermediate and near vision (UDVA, UIVA (66 cm), and UNVA (40 cm) were 20/25, 20/32, and 20/32).
In our patient, IOL decentration confirmed by the ocular wavefront camera was apparently the reason for the unsatisfactory outcome at intermediate and near vision, being this issue was solved after exchanging the Vivity by another multifocal IOL. We hypothesize that the Vivity IOL decentration (4mm) was the reason for the suboptimal intermediate and near visual functions, being this issue fixed after IOL exchange with ATC implantation.
In conclusion, although EDOF IOLs are supposed to be more immune to optical quality degradation caused by IOL decentration compared to multifocal IOLs, in the current case we show the relevance of proper centration of the optical part of the Vivity EDOF lens in order to achieve a satisfactory vision for both intermediate and near. We recommend the use of CTR at the moment of IOL implantation for the prevention of a postoperative decentration that could lead to unsatisfactory visual outcome.
Eposter
On-demand
On-demand

P055
OCCURRENCE OF CORNEAL STAINING AFTER CATARACT SURGERY WITH AND WITHOUT CHITOSAN-N-ACETYLCYSTEINE EYE DROPS
Stefan Palkovits
Cataract
Stefan

Palkovits
Austria
Increased corneal staining is a common problem after routine cataract surgery. Affected patients suffer from complaints such as foreign body sensation or pain. The present study seeks to investigate the occurrence and magnitude of postoperative corneal staining and further the possibility of its prevention using chitosan-N-acetylcysteine eye drops.
All study-related measures as well as data collection were performed at the Department of Ophthalmology at the Hanusch Hospital in Vienna.
Patients scheduled for routine cataract surgery were included and randomly assigned to one out of three groups. In group one cataract surgery was performed routinely without additional measures. In group two chitosan-N-acetylcysteine eye drops were administer prior to the surgery and in group three prior and directly after the procedure. Group two and three continued with one daily drop of chitosan-N-acetylcysteine eye drops for five days. Magnitude of staining was assessed using the NEI-score and subjective complaints using a visual analogue scale.
Thirty-six patients were included in the final analysis. We found a statistically significant increase in corneal fluorescein staining and VAS scale, one hour after cataract surgery in all groups, which returned to baseline values after one week. There was no significant difference between the groups. However, a tendency towards lower NEI scores was observed in group 3 one hour after cataract surgery.
Cataract surgery led to significant increase in corneal staining and VAS after one hour. Though statistically significant the increase in VAS score was small and probably not clinically relevant. We observed a tendency in reduction of corneal staining in group three. Nevertheless, perioperative chitosan-N-acetylcysteine eye drops did not reduce the rate of corneal staining after cataract surgery in a clinically relevant manner.
Eposter
On-demand
On-demand

P056
IOLZERO: A WEB APPLICATION FOR CALCULATIONS, OUTCOMES TRACKING AND OPTIMIZATION IN CATARACT SURGERY
Miguel Raimundo
Cataract
Miguel

RAIMUNDO
Portugal
Cataract surgery results can be improved by a data-driven approach: outcome tracking (visual acuity, residual refraction, and complications) as well as optimization (formulas, constants, SIA, ...). Most health record systems in ophthalmology are not tailored to these specific tasks. Alternative software tools that implement some of these analyses are usually commercial in nature and/or locked to a specific biometer analysis pipeline. Many of these calculations are complex and error prone and some of them even impossible to replicate in standard spreadsheets. This hinders the adoption of outcome tracking and optimization by many cataract surgeons worldwide.
Tertiary center (university hospital).
Development of a free web application, named IOLzero (available at https://iolzero.com), using a Python backend, optimized for both desktops, tablets and smartphones. The web application is seamlessly updated with new tools, IOLs and biometers. The surgeon can define his default preferences (preferred incisions, IOL models, formulas, ...). All analysis and calculations follow literature standards, which are properly referenced. Patient identifying data is processed locally (never leaves the browser), ensuring privacy. Individual case data can be exported to conventional text-based electronic health records by user-defined templates. All data can be exported to spreadsheets for further analysis by the surgeon.
The 'Patients' module implements a cataract focused registry with preoperative biometry, surgical details, and a final post-operative evaluation. The 'Analysis' module can evaluate clinical outcomes (visual acuity, complications, and residual refractive errors), formula comparison (prediction errors with graphical evaluation), formula optimization (A-constant optimization and mean target optimization for unpublished formulas) and SIA calculation (by laterality, incision type and location). Auxiliary calculators for IOL calculation (SRK/T, Holladay 1, Haigis and HofferQ), Wang-Koch optimization for axial myopia, Cooke-modified axial length for sum-of-segments approximation, second eye refinement, pediatric IOL calculator, multi-device keratometry vectorial averaging, sulcus power adjustment, among other tools, are also available on IOLzero.
We believe IOLzero is a valuable tool for cataract surgeons interested in improving their results by a systematic process of data analysis and optimization, while not being locked down to a commercial solution or a specific biometer.
Eposter
On-demand
On-demand

P057
TOLERANCE TO RESIDUAL ASTIGMATISM AND LOW SPHERICAL REFRACTIVE ERRORS ON DISTANCE VISION USING A NOVEL PRESBYOPIA-CORRECTING INTRAOCULAR LENS
Laureano Rementeria-Capelo
Cataract
Laureano

Rementeria
Spain
To assess the impact of low residual refractive errors on distance vision in patients using a novel presbyopia-correcting extended vision intraocular lens (IOL).
ClÍnica RementerÍa, Madrid, Spain.
The study included patients with the Acrysof® VivityTM IOL. Distance vision was assessed three months after the surgery without distance correction VA (UDVA), with distance correction (CDVA) and with different refractive conditions: A) with a residual mixed astigmatism induced by adding a combination of -0.25 diopter (D) spherical and 0.50 D cylindrical lenses placed in vertical (against the rule - ATR), oblique and horizontal (with the rule – WTR) positions, B) with a positive (myopization) and a negative (hyperopization) defocus of 0.50D.
A total of 15 eyes of 15 patients were included. UDVA was -0.04±0.06 logMAR while VA with the best distance correction (CDVA) was -0.05±0.05 logMAR. VA values for the ATR, oblique and WTR situations were 0.01±0.06, 0.00±0.06, 0.01±0.05 logMAR, respectively. The VA was better for the reference situation (p<0.001) and no differences were found among the three astigmatic situations (p=0.19). VA values with +0.50 D and -0.50D of defocus were 0.00±0.06 and 0.00±0.04 logMAR, respectively. Similarly, VA was better with distance correction (p<0.001) and no differences were found between the myopic and the hyperopic situations (p=0.43).
Low residual mixed astigmatisms, regardless their orientation, and low positive or negative spherical refractive errors, seem to be tolerated at distance vision in patients with the IOL under study. Despite VA was better for the emmetropic situation, none of the residual refractive errors showed a significant impact on distance VA.
Eposter
On-demand
On-demand

P058
VISUAL AND REFRACTIVE OUTCOMES OF A NEW EXTENDED DEPHT-OF-FOCUS INTRAOCULAR LENS IN EXTREME CASES
Filomena J Ribeiro
Cataract
Filomena
J
Ribeiro
Portugal
To evaluate the clinical outcomes after cataract surgery with the implantation of a new extended-depth-of-focus (EDOF) intraocular lens (IOL) (Alcon AcrySof IQ Vivity) in extreme cases (eyes with previous corneal refractive surgery and keratoconus).
Hospital da Luz, Lisbon, Portugal
In a prospective case series, 14 eyes of 7 patients undergoing cataract surgery with AcrySof IQ Vivity implantation were enrolled: 4 patients with previous myopic LASIK, 2 patients with previous hyperopic LASIK and 1 patient with keratoconus. The outcomes in terms of distance, intermediate and near visual acuity (VA), refraction, defocus curve, photic phenomena and spectacle independence were evaluated at 3-months follow-up.
Monocular uncorrected distance VA and distance-corrected intermediate and near VA improved in all the patients. Refractive results were good, with 10 of the 14 eyes with 0.50 D of the target. A functional VA of 0.3 LogMAR or better was obtained in all the patients for vergence demands of +0.50 to -3.00 D. The frequency, severity and bothersomeness of different visual symptoms, including glare and haloes was low. After surgery, none of the patients required the use of spectacles for any distance.
The EDOF IOL studied provided an effective visual rehabilitation, resulting in an improved distance, intermediate and near VA, low prevalence of photic phenomena and high spectacle independence. Even in selected extreme cases, EDOF IOLs may be an effective alternative to standard monofocal IOLs.

Eposter
On-demand
On-demand

P059
TOPICAL TIMOLOL 0.25% TO ENHANCE PREOPERATIVE REFERENCE VESSELS IMAGE IN DIGITALLY ASSISTED INTRAOPERATIVE AXIS ALIGNMENT FOR TORIC IOL
Eduardo Roditi
Cataract
Eduardo

RODITI
Israel
When performing biometry with the Zeiss IOL Master 700®, a scleral image (using green monochromatic light, a red-free type image) for clear identification of limbal vessels is captured as a reference for the intraoperative augmented reality axis alignment assistant in the Zeiss Callisto ® microscope. Rarely, an error message appears as'not enough vessels near the limbus have been found', without any proposed solution from the manufacturer instructions manual, even recommending manual marking for toric alignment.
We herein report the use of topical timolol 0.25% drops as an effective method to enhance preoperative limbal vessels reference image and solve effectively the 'unsolvable' error message.
Premium IOL Cataract Clinic at the department of ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.
Case presentation after review of preoperative, intraoperative and postoperative data.
A 71-year-old female patient performed preoperative assessment for programmed left eye cataract surgery with a toric intraocular lens implantation due to regular mild astigmatism, with topography values of K1: 45.25 at 178° K2: 46.09 at 88° ΔK: +0.84 at 88° in the left eye. A T2 toric lens with intraoperative digitally assisted alignment was intended but the error message'not enough vessels near the limbus have been found' kept appearing and no scleral image was captured.
Topical timolol 0.25% drops were instilled in the eye and 20 minutes later biometry was repeated, this time with successful and quality scleral image acquisition.
The day of the surgery topical 0.25% timolol drops were instilled as well and she underwent uneventful phacoemulsification with toric IOL implantation at 88°. On the postoperative one, seven and 30 days follow up visit her UCVA was 20/20 without any disaligment of the IOL.
Timolol 0.25% is a common and available drop preparation at ophthalmic clinics. It is regularly used as an ocular hypotensor medication. Although the mechanism of action by which it induces dilation of conunctival vessels is poorly understood, it has been proven by several studies. Although further studies are warranted, cataract surgeons using the intraoperative alignment technology should be aware of this potential solution to a previously 'unsolvable' error from a modern biometry machine.
Eposter
On-demand
On-demand

P060
ASSESSMENT OF ANTERIOR CHAMBER ANGLE CHANGES AFTER PHACOEMULSIFICATION USING ULTRASOUND BIOMICROSCOPY
Rahma Saidane
Cataract
Rahma

Saidane
Tunisia
We aimed to evaluate the impact of cataract surgery on anterior chamber angle parameters with ultrasound biomicroscopy measurements.
Department of Ophthalmology of the Military Hospital, Tunis, Tunisia.
A prospective comparative study was conducted between January 2021 and June 2021. Forty eyes of 40 patients with no medical history nor ocular diseases, scheduled for cataract surgery, were included.The same experienced surgeon performed phacoemulsification with intraocular lens implantation using the Alcon Constellation Vision System device (Alcon,USA).We noted the patients' best-corrected visual acuity (BCVA), the intraocular pressure (IOP), gonioscopy and fundus examination. We classified the cataract grade according to the lens opacities classification system III (LOCS III) scoring. Anterior segment imaging was performed on each eye using ultrasound biomicroscopy (UBM, Aviso Lin-50; Quantel Medical).We measured biometric parameters of the anterior segment: angle opening distance (AOD 500), angle recess area (ARA 750) and trabecular iris space area (TISA 750).We compared all measurements preoperatively and three months postoperatively.
The mean age was 63.6±10.8(22 female and 18 male).The mean axial length was 23.28±0.70 mm.The mean stage of cataract was 2.46 ± 0.64. No remarkable peri- or postoperative complications were observed. The mean preoperative BCVA improved from 0.36 ± 0.02 to 0.68 ± 0.04 (p<0,05). All iridocorneal angle parameters (AOD 500, ARA 750, TISA750) were significantly larger at the three-month-postoperatively control (all p<0,05). Furthermore, significant reduction in IOP values was also noted (14.83 ± 1.7 vs 13.43 ± 1.50; p=0,028).
Cataract surgery can provide a significant decrease in IOP. It increases in the anterior segment angle parameters measured using UBM in the postoperative period.
Eposter
On-demand
On-demand

P061
CLINICAL CASE OF TRAUMATIC CATARACT SURGERY WITH LENS SUBLUXATION AND FUSED IRIDOCORNEAL SCAR
Oksana Nabatova
Cataract
Sergey

Sakhnov
Russian Federation
The patient had suffered a penetrating corneal injury at the age of 5 years. No surgical intervention was performed. During the course of life, the patient's best corrected visual acuity was 10/30. He came to the clinic at the age of 70 (65 years since the injury). At the time of examination, he was found to have accurate projection of light in all directions. Before mydriatic instillation, the pupil was not visualized and the iris was stretched in a solid'sail' by 5 o'clock, into the limbal scar. The aim of the intervention was to restore the patient's accustomed visual acuity.
Clinical case conducted at the S Fyodorov Eye Microsurgery Federal StateInstitution - Krasnodar, Russia.
The decision has been made to perform cataract phacoemulsification with monofocal IOL implantation and iris plastics with pupil shaping.
The surgery was performed with application of iris retractors to the pupil margins. The lens ligament apparatus was incompetent and there was rather significant phacodonesis, therefore anterior capsulorhexis was not easily performed, after which the retractors were moved to the edges of the capsulorhexis. The intracapsular ring was implanted. After hydrodissection was performed, phacoemulsification of the cataract was performed. The crystalline lens nucleus was very dense and viscous, which made it difficult to destroy. Capsular sac was fully preserved. After washout of cortical masses, the intraocular lens prepared for implantation was stitched at the base of both arches with 8.0 polypropylene thread, one end of which was fused with electrocautery to form a fixation flange on the lower surface of the lens. The IOL was then implanted into the capsular bag with an injector. And sclerocorneal suturing according to Kozhukhov - Telegin was performed. The next stage was isolation of iris section, soldered into limbal scar and joining of resulting flaps by nodal sutures with formation of pupil.
Even 65 years after an eye injury, it is reasonable not to limit treatment to the phacoemulsification of a cataract, but to restore the anatomical correspondences by performing iris plastics to achieve a satisfactory visual acuity. As a result of the intended surgical intervention, the patient regained his habitual visual acuity: 10/30. The patient was satisfied with the result.
Eposter
On-demand
On-demand

P062
COMPARAISON OF VISUAL ACUITY AND EVERYDAY PERFORMANCE BETWEEN EXTENDED DEPTH OF FOCUS AND MONOFOCAL INTRAOCULAR LENSES AFTER BILATERAL IMPLANTATION: A PROSPECTIVE RANDOMIZED STUDY.
Dounia Bradly
Cataract
Dany

SALIK
Belgium
Implantation of a monofocal intraocular lens is the current gold standard in cataract surgery, rending patients dependent on glasses after surgery. New implants with enhanced depth of focus could improve intermediate and near visions with uncompromised far visual acuity and limited dysphotpsia.
The objective of this prospective study was to compare a bilateral implantation of an extended depth of focus intraocular lens - Isopure® - versus a bilateral monofocal intraocular lens with same material and basic design - Micropure® - (PhysIOL, Belgium).
This multicentric study was conducted in two university hospitals in Brussels, Belgium.
Eligible patients with bilateral cataracts were randomly assigned to two groups. Monocular and binocular, corrected and uncorrected, near (40cm), intermediate (80cm) and far (4m) visions were measured before and after their operations using ETDRS charts. A pre- and postoperative questionnaire was realized in order to assess the impact of their vision on their daily tasks.
This prospective, randomized, double-blind study included 8 patients in the Isopure® group and 10 patients in the Micropure® group. Near and intermediate visual acuities were found to be significantly better in the Isopure® group. Near visions was respectively 0.27 ± 0.13 and 0.50 ± 0.13 LogMar (p-value=0.0037) while intermediate vision was 0.02 ± 0.08 and 0.21 ± 0.08 LogMar (p-value<0.001). No significant difference was demonstrated in the corrected monocular far vision (p-value 0.5490 and 0.1194). The questionnaires showed that patients in the Isopure® group had significantly fewer difficulties with daily activities including more independecy of their glasses. The overall questionnaire satisfaction was equivalent in both groups.
The Isopure® intraocular lens significantly improved intermediate and near vision while providing daily visual comfort, compared to its Micropure® homolog.
Eposter
On-demand
On-demand

P063
TRIFOCAL IOLS TO CORRECT REFRACTIVE DEFECTS AND PRESBYOPIA AFTER CATARACT SURGERY: NEW GUIDELINES FOR USE IN THE MAJORITY OF PATIENTS
Gabriele Scaltrini
Cataract
Gabriele

Scaltrini
Italy
To evaluate results in cataract eyes trifocal IOLs implantation to provide distance intermediate and near vision.Minimal postop refractive defects provide high quality of vision and patients satisfaction.New center organization and preop eyes evaluation are key points to spread the use of trifocal lenses to the majority of cataract patients
Piovella Global Center For Ophthalmology
630 eyes with cataract were implanted with trifocal IOLs.283 eyes(44.9%)with ATLISA tri 839MP-Carl Zeiss Meditec AG Jena and 347 (55.1%) eyes were implanted with AT LISA tri 939MP - Carl Zeiss Meditec AG Jena. Bilateral implant 288 patient 99 Patients implanted with both TRIFOCAL IOLs(34.3%) 129 Patients implanted with both TORIC TRIFOCAL IOLs (44.8%) 60 Patients implanted with TRIFOCAL IOL in one eye and TORIC TRIFOCAL IOL in the other eye (20.9%) Mean Age 66.49 ±11.66 IOL calculations were performed adopting advanced biometry instruments and astigmatism axis alignment performed with digital system. Tears film quality and MGD was always detected Lipiflow and Blephex were applied routinely
At 5 years monocular Trifocal IOLs results are UCDVA 20/22 ± 2.40 UCIVA 20/24 ± 3.13 UCNVA 20/27 ± 5.37 , monocular Toric Trifocal IOLs are UCDVA 20/20 ± 3.25 UCIVA 20/35 ± 4.75 UCNVA 20/29 ± 2.56 Binocular results (178 patients) are UCDVA was 20/20, intermediate 20/20 and near vision 20/24 96 % OF PATIENTS IN THE RIGHT RANGE (Almost One Eye in the Right Range Sphere Equivalent Within - ±0.50 Sph) Toric IOLs correction is mandatory when 0.75 D of corneal astigmatism is detected. It is necessary to determinate total corneal astigmatism to provide best refractive postoperative outcomes. We have adopted IOL Master 700 TK for the purpose to measure anterior and posterior corneal curvature
AT LISA tri toric 939MP and AT LISA tri 839 MP trifocal IOLs are the most efficient today development of multifocal IOLs family. Clinical outcomes indicate that this is an effective multifocal design to correct refractive defects and to defeat presbyopia after cataract surgery. Data show that it is possible to adopt them in the majority of patients
Eposter
On-demand
On-demand

P064
CHANGE OF CORNEAL CURVATURE FOLLOWING NON-ABLATIVE THERMOMECHANICAL SKIN TREATMENT FOR DRY EYE DISEASE
Sunil Shah
Cataract
Sunil

Shah
United Kingdom
To determine the change of corneal curvature following novel thermo-mechanical action based peri-orbital fractional skin treatment for the treatment of dry eye disease (DED) with reference to importance for intraocular lens (IOL) calculation and refractive surgery.
A multicentre, prospective, controlled, open labelled study was conducted at Midland Eye, UK, Vallmedic Vision, Andorra and Khmer-Sight Foundation, Cambodia.
Consented participants attended visit-1, 2, 3, and 4 every two weeks and visit-5 for 3 months follow up. Participants received three sets of skin treatments for dry eye on visit-1, 2 and 3. Detailed ophthalmic examinations including vision, intraocular pressure (IOP), were conducted as well as corneal topography.
One hundred and forty one participants (105 females; mean age 55.26±14.54years) with signs and symptoms of DED. This novel dry eye treatment was associated with no adverse events. DED as measured by OSDI questionnaires, tear break up time and tear osmolarity showed significant improvements in DED. Following cumulative analysis, a total of 3.5% of participants had more than 1 Dioptre change in mean keratometry (which results in more than 1D change in the power of the calculated IOL), 5.7% had more than 0.75 dioptres and 9.9% had more than 0.50 dioptre change in keratometry following treatment.
Thermo-mechanical action based peri-orbital fractional skin can have a significant impact on corneal curvature measurement. It is vital to treat dry eye first before performing biometry or refractive surgery, if not, major refractive errors from measurement error may result.
Eposter
On-demand
On-demand

P065
CAPSULAR IRRIGATION WITH ANT-VEGF IN PEDIATRIC CATARACT SURGERY
Alaa Abdalsadek Ahmed Sinjab
Cataract
Alaa
Abdalsadek Ahmed
Sinjab
Egypt
To determine the safety and efficacy of irrigation of the capsular bag with ant-VEGF during pediatric cataract surgery.
Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University
15 eyes of 9 children (Age 18-42 months, average 26 months) with isolated congenital cataract underwent irrigation/aspiration with primary PCIOL implantation. Principles included anterior CCC, I/A, irrigation with ranibizumab for two minutes, BSS irrigation, post. CCC, 3-piece IOL inserted in the ciliary sulcus with optic capture.
Control group: 30 eyes of 18 children with isolated congenital cataract underwent the same procedure without use of ranibizumab.
Outcome measures: at 6 months postoperative
Vision, visual axis opacification, postoperative complications.
Vision (preferential looking): Study group ( 12 eyes good vision, 3 eyes fair vision), control group (25 eyes good vision, 5 eyes fair vision), no statistically significant difference.
Postoperative complications: 2ry glaucoma (2 eyes of study group, 3 eyes of control group), early postoperative iritis (1 eye in both groups), no statistically significant difference.
Visual axis opacification and PCO: 4 eyes in study group and 5 eyes in control group, no statistically significant difference.
Irrigation of the capsular bag with ranibizumab during congenital cataract surgery is a safe technique. However, it showed no additional benefits in preventing PCO. Further studies on large sample are recommended.
Eposter
On-demand
On-demand

P066
TEMPERATURE OF IRRIGATING FLUID DURING PHACOEMULSIFICATION AND ENDOTHELIAL CHANGES
Alaa Abdalsadek Ahmed Sinjab
Cataract
Alaa
Abdalsadek Ahmed
Sinjab
Egypt
To determine the effect of irrigating fluid temperature on corneal endothelieum during phacoemulsification.
Department of Ophthalmology, Sohag faculty of medicine. Sohag University
100 eyes with senile cataract underwent uneventful phacoemulsification.
Group A; 50 eyes, Irrigating fluids kept at room temperature (20±1° c) were used.
Group B; 5o eyes, cold irrigating fluids kept at 14±1° c were used.
Both groups were matched for age, lens opacity grade system (LOGS) and preoperative endothelial cell density and hexagonality.
Outcome measures: at three months postoperative:-
Corrected distance visual acuity (CDVA), endothelial cell density and hexagonality, intraoperative and postoperative complications.
This was a prospective interventional study. CDVA three month postoperatively ranged from 0.4-0.2 in LogMAR, average 0.25. there were statistically insignificant difference (p value> 0.05) between both groups as regards CDVA, endothelial changes, intraoperative and postoperative complications.
Cold irrigating fluid showed no superior benefits over fluids kept at operative room temperatue.
Eposter
On-demand
On-demand

P067
VISION ACUITY AND OBJECTIVE SCATTER INDEX (OSI) CORRELATION IN CATARACT PROGRESSION MONITORING
Maksim Solomatin
Cataract
Maksim

SOLOMATIN
Latvia
To evaluate the correlation between the vision acuity and the Ocular Scatter Index (OSI) monitoring patients with diagnosed cataract.
10 eyes with diagnosed cataract of 10 patients were monitored during 4 month.
The vision acuity, the Ocular Scatter Index were measured and slit lamp exam was performed during every visit. Four visits were included in the study design - the initial visit, 1 month, 2 months, 4 months. The OSI was measured using the HD analyzer equipment (Keeler USA).
There was a negative correlation between two values (vision acuity and the Ocular Scatter Index) found in the study timeframe that was statisctically significant (p<0,05). First month r=-0,79, p<0,05, second month r=-0,56, p<0,05, fourth month r=-0,67, p<0,05.
The decrese of the vision acuity was accompanied by the increase of the OSI values during the period of observation, and vice versa.
The Ocular Scatter Index is an effective instrument for cataract progression monitoring and screening, that is very helpful in the settings of cataract and refractive surgeon clinic.
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On-demand

P068
NOVEL INDICATION FOR THE USE OF ADD ON INTRAOCULAR LENS IN THE MANAGEMENT OF CAPSULAR BAG DISTENSION SYNDROME
Sathish Srinivasan
Cataract
Sathish

Srinivasan
United Kingdom
To report on a novel indication for the use on an add on / piggyback IOL in the management fo capsular bag distension syndrome following refractive lens exchange.
Department of Ophthalmology, University Hospital Ayr, Ayr, Scotland, UK
Invertentional case report. A 65 year caucasian female a know hyperope underwnet refractive lens exchange with bilateral implantation of trifocal introacularl lenses. The surgical procedure was uneventful. In the post operative period she was noted to have a myopic surprise in the right eye. Clinical investigations revealed capsular bag distension syndrome in the right eye which was initially treated with yag laser posterior capsultomy.
To deal with the residual refractive error causby the capsular bag distension she underwent a secondary add on IOL implanation as a plannded secondary elective procedure which resulted in emmetropial.
Add on / piggyback IOL can be a novel indcation for use in the management of residual refractive error following capsulr bag distension syndrome.
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P069
THE IMPACT OF MYOPIA ON THE DEVELOPMENT OF CATARACT – PRELIMINARY REPORT.
Marta Świerczyńska
Cataract
Marta

Świerczyńska
Poland
To investigate the effect of myopia on the process of the lens opacity and the development of cataract.
Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia in Katowice, Katowice, Poland
The study included patients qualified for cataract surgery. Group 1 consisted of participants with myopia (confirmed by autorefractometry at least 4 years before the onset of cataract - spherical equivalent (SE) ≤ -1 D), divided into three subgroups: low (≥ -3,5 D SE ≤ -1 D); medium (≥ -6 D SE< -3,5 D); high (SE< -6 D) myopia. Group 2 included normo-sighted (> -1 D SE< +1 D) and hyperopic (SE ≥ +1 D) patients age and gender matched for group 1. People with factors that have a documented effect on the acceleration of cataract development were excluded from the study. Participants underwent a comprehensive ophthalmic examination including measurement of refraction, the axial length of the eyeball, assessment of lens opacities using the Lens Opacities Classification System III. A questionnaire was used to collect medical history and background check.
Both groups included 100 eyes (119 women and 81 men), mean age of patients was 72 ± 8.1 SD (ranging from 45 to 86 years old). Average SE among myopic patients was - 4,65 ± 2,2 SD (up to - 24,25 D) and in group 2 amount to +1,44 ± 1,7 SD (maximum + 9,0 D). Nuclear cataract was the most common distinct subtype (36,7%). There was a statistically significant association between myopia, especially high, and incident nuclear and posterior subcapsular (PSC) cataract, after adjustment for multiple confounders and severity of nuclear opacity. Moreover, smoking, exposure to sunlight as well as iris atrophy contribute to development of lens opacity.
These epidemiologic data provide that compared to emmetropia, myopia is associated with increased risk of nuclear and PSC cataract subtypes. Improved understanding of risk factors for cataract would help to identify high-risk groups and personalize the diagnostic and therapeutic path.
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P070
COMPLICATIONS OF EMPIRIC TREATMENT OF CATARACT BY COUCHING
Mekyna Synthia
Cataract
Mekyna

Synthia
Morocco
To determine complications of empiric treatment of cataract by couching.
Traditional lens lowering is still practiced in some developing countries. The complications of this empirical technique are serious and represented by glaucoma, retinal detachment and endophthalmitis.
We report the case of phacoantigenic uveitis and hypertonia following lowering of the lens.
A 70-year-old woman consulted for a red and painful right eye that had progressed for 7 days. She is type 2 diabetic, illiterate and comes from a modest social background. She reported on a traditional lens lowering notion of the eye 3 weeks ago.
The ophthalmologic examination of the right eye found visual acuity to count the fingers closely, significant inflammation in the anterior chamber, grade 1 hyphema, a wick of vitreous in the anterior chamber, hypertonia at 45 mmHg and a luxated cataract lens in the vitreous, mobile according to eye movements and confirmed on ocular ultrasound. Examination of the left eye mainly notes visual acuity including the fingers and a cataract lens.The patient underwent emergency hypotonizing treatment, corticosteroid therapy and an anterior and posterior vitrectomy with phacofragmentation, without implantation in the right eye.
In conclusion, patients who are victims of this archaic practice are exposed to numerous complications which are often of poor prognosis. Hence the interest of informing and sensitizing populations in precarious socio-economic and intellectual situations.
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P071
MANAGEMENT OF BLACK CATARACT
Adrian Teodoru
Cataract
Adrian

TEODORU
Romania
Mature cataract is a neglected cataract that in time (years) leads to a marked decrease of the visual acuity. In most of the cases the nucleus of the lens gains a high density, requiring a larger amount of phaco energy during the phacoemulsification process.
The paper presents two different methods of surgical approach in two mature cataracts, chosen according to the risk-benefit analysis.
The paper presents two different methods of surgical approach in two mature cataracts, chosen according to the risk-benefit analysis.
Both cases had favorable evolutions, the functional results being similar postoperatively.
Phacoemulsification can be a challenge in black cataracts, therefore classic extracapsular cataract extraction should be considered as an alternative in some cases.
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P072
DYSPHOTOPSIA DUE TO RETAINED CAPSULORHEXIS MEMBRANE ADHERING TO PUPILLARY MARGIN IN PIGMENTARY GLAUCOMA.
Irena Serov Volach
Cataract
Suresh

Thulasidharan
United Kingdom
To describe a case of successful treatment of dysphotopsia induced by retained capsular rhexis fragment after standard uncomplicated phacoemulsification.
Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Fifty-year-old office worker with medically well controlled pigmentary glaucoma presented with reduced visual acuity secondary to cataract. She underwent a standard uncomplicated phacoemulsification with predicted post operative refraction aimed at myopia as per her needs. She presented to our emergency unit with flashes and was noted to have peaking of pupil at three o'clock and suspected vitreous like strand and no active inflammation. Dilated fundoscopy revealed no retinal breaks and healthy peripheries.
Patient underwent a further procedure with planned anterior vitrectomy to release the supposably tractional element. A Kenalog injection did not identify any vitreous. A sweep above and below the iris did not show any obvious traction. Attempt with the vitrector or Simcoe aspiration did not remove the transparent membrane. This was possibly a retained capsular rhexis membrane adhering to the iris. Grasping with forceps countered with traction by ironing out iris released this membrane (figure 2) leading freeing the pupillary margin to natural contour. This relieved the symptoms of the flashes and she recovered with vision of 6/5.
Dysphotopsia due to peaking at pupil from a capsular membrane adhered to iris was successfully relieved shows the significance of removal of the capsular rhexis disc completely before commencing further steps of the surgery, especially in pigmentary glaucoma.
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P073
CLINICAL OUTCOMES OF A NEW MONOFOCAL INTRAOCULAR LENS IN PATIENTS WITH PRE-EXISTING COMORBIDITIES
Jan Venter
Cataract
Jan

Venter
United Kingdom
To assess and report on the safety and efficacy of the new TECNIS Eyhance monofocal intraocular lens in patients with pre-existing comorbidities.
Private Surgery Centre (UK)
48 patients, 92 eyes, with pre-existing comorbidities, who underwent cataract surgery or refractive lens exchange with unilateral or bilateral implantation of the TECNIS Eyhance ICB00 were retrospectively reviewed. The following comorbidities were included: lazy eye, squint, macular degeneration, retinal problems, ocular hypertension, glaucoma, and keratoconus. The age range of patients was 39 to 75 years. Postoperative clinical safety, efficacy, and patient-reported outcomes up to 12 months following implant were analysed
Mean gain in visual acuity lines for uncorrected distance, intermediate, and near was 8, 4, and 4, respectively. No patients lost more than 2 lines of BCVA, while 88% were ±1 line from preoperative BCVA. The rate of postoperative adverse events related to the IOL remains low and is comparable to patients with no pre-existing comorbidities who were implanted with the Eyhance lens. No patients reported experiencing severe difficulty with glare, halo or starbursts. 82% of patients reported being satisfied or very satisfied, while 99% would recommend the procedure to friends and family
Outcomes of this retrospective analysis suggest the new Eyhance monofocal intraocular lens may be a safe and efficacious option for patients with pre-existing comorbidities. Thus far, the IOL showed low incidence of visual phenomena and complications within the first year. A larger data sample with longer follow-up is warranted to confirm.
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P074
FIRST RESULTS WITH A REFRACTIVE SEGMENTAL BLUE LIGHT FILTER LOW ADD EDOF (+2.0D ADD) IOL
Verena Zeitz
Cataract
Verena

Zeitz
Germany
Until now there exists no refractive segmental low add EDOF IOL with a blue light filter and near add of +2.0D. Therefore, the aim of this investigation was to evaluate the clinical outcomes in patients implanted with this EDOF IOL with a blue light filter.
All surgeries were performed by one surgeon at the Breyer-Kaymak-Klabe Eye Surgery and Premium Eyes in Duesseldorf, Germany, member of the International Vision Correction Research Center (IVCRC.net).
20 eyes of 10 patients with cataract and expected postoperative corneal astigmatism of under -0.75D were included. In all eyes, a new low add EDOF IOL with +2.0D addition (Visiotis Progress+; IOL-Expert, Germany) was implanted. We assessed defocus capacity after 3 months postoperatively and compared it with defocus curves of other EDOF IOL. Halo and glare phenomena were evaluated by a patient questionnaire.
The defocus curve showed better intermediate and near vision compared to monofocal IOL and other refractive EDOF IOL. Evaluation of the patient questionnaire indicated less halo & glare phenomena than in diffractive trifocal MIOL and bifocal EDOF IOL.
Visiotis Progress provides a new optical design. Independence from glasses with less halo and glare than trifocal MIOL was achieved. We implanted this EDOF IOL as Mini Monovision. Thus, the patients can see far, work in PC and laptop distance and read usual book- and newspaper print without glasses without suffering from photopic phenomena. We also implant this EDOF IOL in the Duesseldorf Formula mode as blended vision (target refraction in dominant eye is emmetropia and in the non-dominant eye -1.5D). This even enables patients to read small print.
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P075
FIRST EUROPEAN COMPARATIVES CLINICAL RESULTS FOR A VIOLET LIGHT FILTERING TRIFOCAL IOL
Verena Zeitz
Cataract
Verena

Zeitz
Germany
The goal was to compare a new trifocal MIOL with violet light filter with well-established trifocal MIOL (LISA, CZM and Panoptix, Alcon).
All surgeries were performed by one surgeon at the Breyer-Kaymak-Klabe Eye Surgery and Premium Eyes in Duesseldorf, Germany, member of the International Vision Correction Research Center (IVCRC.net).
20 eyes of 10 patients with cataract and expected postoperative corneal astigmatism of under -0.75D were included. In all eyes, a new hydrophobic diffractive refractive aspheric trifocal MIOL with violet light filter (Optiflex Trio; Biotech, India) was implanted. We assessed subjective refraction, monocular uncorrected and best distance corrected visual acuity for far, intermediate and near distances, and monocular defocus capacity after 3 months postoperatively. Halo and Glare phenomena were documented in a patient questionnaire.
The defocus curve showed comparable far, intermediate and near vision to both well-established trifocal MIOL. Evaluation of the patient questionnaire also indicated similar halo & glare phenomena like in patients with both comparative trifocal MIOL.
The visual outcome of Optiflex Trio was comparable to both well-established trifocal MIOL. The defocus capacity of this violet light filtering trifocal MIOL is more like that of Panoptix. Optiflex Trio is an interesting alternative to LISA and Panoptix.
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P076
REFRACTIVE OUTCOMES AFTER PHOTOREFRACTIVE KERATECTOMY (PRK) FOR THE CORRECTION OF HIGH MYOPIA: A RETROSPECTIVE STUDY.
Albanderi Alhamzah
Refractive
Albanderi

Alhamzah
Saudi Arabia
To study refractive Outcomes and patient satisfaction After PRK and transPRK for The Correction of high Myopia: A Retrospective Study.
All information are collected from Dr. Sulaiman Al Habib Hospital data system.
•A retrospective descriptive cohort consecutively included 80 eyes with high myopia (spherical equvelent is -6 or less).
Eyes with compound myopic astigmatism and mixed astigmatism that had undergone PRK and TransPRK treatment..
•Pre- and post-operative visual and refractive data, as well as patient's reported satisfaction were analyzed from the year of 2014 until the year 2020.
Out of 80 eyes included, 40 were males and 25 undergone TransPRK. Myopic refraction ranges from -6.00 to -11.00 before treatment and ranges from Plano to +1.75 at last follow-up.
Twenty-eight percent of patients reported overall satisfaction while 24% were very unsatisfied. Satisfaction with quality of daytime vision without correction and quality of daytime vision with correction reported by only 20% and 8% while 20% and 36% were very unsatisfied. Quality of vision during driving at night was very poor in 20% of patients. Glare problems reported by 24% and 20% did not report glares.
(( Please note that this study is still ongoing to finalize the refractive outcomes))

PRK and TransPRK showed regression after long term follow ups and acceptable patient satisfaction rate.
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P077
SEEING THROUGH THE EYE OF THE NEEDLE
Júlio Almeida
Refractive
Júlio

Almeida
Portugal
To report a case of a pinhole effect intraocular lens (IOL) implantation in a pseudophakic patient with high irregular astigmatism post penetrating keratoplasty.
Prof. Doutor Fernando Fonseca Hospital, Amadora, Portugal.

The pinhole effect reduces the circle of least confusion by cutting down the light divergence and spherical aberrations. This principle can be adapted to IOLs like the XtraFocus Pinhole Implant™ by Morcher®. This posterior chamber IOL is composed by acrylic hydrophobic material and is indicated for secondary implantation in the ciliary sulcus. There are multiple clinical indications for its implantation such as corneal ectasias, especially advanced keratoconus, but it can be implanted after radial keratotomy, penetrating keratoplasty (PK) or after LASIK when other strategies didn't work. We present a case of a 69-year-old female with a previous history of cataract surgery with monofocal posterior chamber IOL implantation followed by penetrating keratoplasty in the left eye (OS).
Five years later, her best corrected visual acuity (BCVA) of counting fingers mostly due to a 10 diopter irregular astigmatism. Unable to correct this astigmatism with other therapeutic options and predicting the benefits of the pinhole effect, we opted for the secondary implant of a posterior chamber IOL using the model XtraFocus™ by Morcher® in the ciliary sulcus. After the procedure, the patient was very satisfied having a BCVA of 6/10.
The use of the pinhole effect in IOL seems to be a safe and effective strategy in very well selected cases. There is a small surgical learning curve, and it offers a big improvement in the visual acuity when other strategies don't work.
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P078
MACHINE LEARNING PREDICTION OF EYEGLASS LENS POWER USING SIMPLE MOBILE CAMERA
Saif Aldeen Alryalat
Refractive
Saif Aldeen

ALRYALAT
Jordan
To develop a machine learning machine learning based model that can predict the dioptric power of lenses used in eye glasses using a simple mobile camera.
Department of Ophthalmology, The University of Jordan, Amman, Jordan.
Data acquisition performed through a pre-designed system to capture images using different lens powers and different settings. The system comprises a specifically designed chart printed on an A4 paper to be imaged, a trial lens and a camera holders that can be adjusted manually, and a mobile camera (iPhone X). We used the camera to image the chart through different trial lenses, where we first neutralized the autofocus function on mobile camera. Images were captured from different distances and in different illumination settings using spherical trial lenses. Spherical lenses used differed by 0.5 diopters. The generated images underwent a pre-processing step. After that, we designed a machine learning model using k-nearest neighbors algorithm (k-NN) and reported its accuracy and the error in diopteric power
A total of 175 images were captured, pre-processed and fed into the machine learning model. The dioptric power of lenses used ranged from +3 diopters to -8 diopters, with a median power of -3. The ground truth predicted was the power of trial lens used to capture the image. The model was able to predict the power of lenses used with 95% accuracy. The dioptric power for prediction error ranged from 0.5 diopters to 2 diopters.
This study represent the development of the first artificial intelligence model that can predict the power of spherical lenses using simple mobile camera. Such model will provide important information for ophthalmologists and optician performing a tele-medical consultation or consultation in remote areas where no lensometers available.
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P079
ACUTE MYOPIA DUE TO TOPIRAMATE TREATMENT – CASE REPORT AND REVIEW OF THE LITERATURE
Ines Artola
Refractive
Ines

Artola
Spain
The purpose of this communication is to make a review of the literature about two of the possible ocular effects of topiramate: acute myopia and angle closure glaucoma (ACG). We will do it from a case seen in our hospital.
Topiramate is a sulfamate-substituted monosaccharide used as anticonvulsivant and migraine prophylaxis. Many adverse effects have been described due to this drug; however, we will focus in two of them: acute myopia and ACG. Both are thought to have the same pathogenesis. The underlying mechanism is a ciliochoroidal effusion, which causes a ciliar body edema, resulting in the zonular fibers relaxation and lens thickening, which explains an acute myopia. This leads to an anterior prolapse of the lens which results in an occlusion of the acuous humor drainage, causing an ACG.
A case from our urgencies was selected. This presents a 23-year-old woman who claimed binocular vision loss in the last 24 hours. She referred far vision loss, but normal close vision. She related it to a change in her anxiety and migraine medication: topiramate. She changed from 25mg to 50mg a day. No other symptoms were referred. A general ophthalmologic exploration was made, which included: visual acuity (VA), intraocular pression (IOP), autorefractometer, intraocular and extraocular movements, cover test, biomicroscopic, funduscopy and OCT.
The VA was R 0,03 / 0,1 and L finger counting 1m / 0,2. IOP was 21mmHg in both eyes. AR showed -5,75 and -4 diopters (dp) in the right (R) and left (L) eye respectively before cycloplegic and R -5dp and L -4dp after cycloplegic. Extraocular movements were normal, except for refixation movements in the lateral eye movements. The anterior OCT showed narrowed angles in both eyes. The rest of the exploration, including funduscopy, showed no alterations. Therefore, topiramate induced myopia was diagnosed, and topiramate was suspended.
One week later, VA was 1 in both eyes. IOP was 15/17mmHg. AR showed -0,25 R and +0,5dp L. In the OCT wider angles were shown in both eyes.
Acute myopia is a well-known adverse effect of topiramate. It usually resolves after abandoning topiramate treatment. This case highlights the importance of a good clinical history and broadens the possible causes of vision loss. This could apply to ACG; even though this patient didn't suffer it, IOP elevation and iridocorneal angle narrowing were noted.
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P080
ROTATIONAL STABILITY AND CENTRATION OF A TORIC LENS USING THE ITRACE

TECHNOLOGY
Jesús María Carpintero Sánchez
Refractive
Jesús
María
Carpintero Sánchez
Spain
To determine the rotational stability of the Asqelio Toric Monofocallintraocular lens (IOL) (AST, Boston, Masschusets) using objective image andItrace (Tracey, Houston, Texas) technology.
the estudy was done at Hotpital La Fe, Valencia, Spain
A total of 30 patients (mean age: 69 ± 8.5 years) with healthy eyes andastigmatism in biometrics> 3 Prismatic Diopters (PD), presenting cataractsurgery were implanted monocularly with the Asqelio Toric Monofocal IOL andfollowed up to 90 days postoperatively. Images of the IOL were captured withthe Itrace technology through a maximally dilated pupil immediately aftersurgery and after 1 to 3 days, 30 days, and 90 days. Centering of the IOLwere analyzed with Itrace technology through angle kappa and alphadistance and the tilt of the IOL through the measurement of the coma.
Absolute values for centering of the IOL postoperatively were related to anglekappa positive in all cases, ranging from +1° to +5°. The mean angle kappawas 2.68° and 2.10° in the right and left eye, respectively. Different subjectiveperception of photic phenomena between the two eyes was recorded only in2 patients. Wave aberration measurements of the same IOL were highlyrepetitive (deviation<0.02 μm). Coma increased with decentration at a rate of0.18 μm / mm and 0.19 μm in the right and left eye, respectively.
The Asqelio Monofocal Toric IOL showed good rotational stability afterimplantation. The measurements with the Itrace technology suppose a perfectsystem for evaluate the postoperative centering and the tilt of the lensassuming an improvement of the visual quality of the patient.
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P081
PILOT TRIAL RESULTS OF LASER SCLERAL MICROPORATION IN PRESBYOPIC EYES
Magda Rau Dr.
Refractive
Magda
Rau
Rau
Germany
To evaluate visual benefit of Laser Scleral Microporation (LSM) in presbyopic eyes.
Augenklinik Cham
Scleral microporations were performed in critical zones in four quadrants using an Er:YAG laser to improve pliability & biomechanical efficiency of the accommodative apparatus for 22 patients. Patients were over 40 years of age with demonstrated loss of accommodative abilty. Visual outcomes were assessed using the Early Diabetic Retinopathy Study (EDTRS) logMAR charts with and without correction at distance, 60cm and 40cm.
LSM provided improved uncorrected monocular UDVA, UIVA, UNVA from 0.02, 0.20 and 0.43 preoperatively to -0.02, 0.02 and 0.20 at 6 months respectively postoperatively. Distance corrected intermediate and near visual acuity (DCIVA, DCNVA) improved from 0.18 and 0.46 to 0.00 and 0.19 respectively postoperatively with no reduction in distance vision. Spherical equivalent of the manifest refraction was not significantly different from 0.18D (SD 0.27D) preoperatively to 0.21D (SD 0.27) six months postoperatively. Refractive power required to read letters at the logMAR 0.00 level dropped from 2.03D (mean) to 1.15D (mean) at 6 months post-operatively.
Early clinical trial results suggest LSM to be a safe and effective procedure for restoring range of visual performance in presbyopes. Early results also suggest that LSM can improve intermediate and near visual acuity without touching the visual axis and without comprising distance vision. Data collection is ongoing.
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P082
A COMPARISON BETWEEN TWO MULTIFOCAL I0LS WITH ASYMMETRIC OPTICS MADE FROM DIFFERENT MATERIALS
Magda Rau
Refractive
Magda
Rau
Rau
Germany
To establish whether the different materials of these IOLs influence the optical and functional result after their implantation?
A private ophthalmic clinic Augenklinik Cham,Germany
One arm of the study consisted of them Oculentis Mplus X IOL made of a hydrophilic copolymer with 25% water content and a hydrophobic surface. It has a, UV filter and a refractive index of 1.,46.
The other IOL was the Teleon AcunexVariomax. This is made of a hydrophobic material designed to be, glistening-free. The refractive index is 1.54 with a water content of 4%. As well as the UV filter there is one for blue light.
40 eyes of 20 patients were implanted bilaterally in each arm. The results were compared in a retrospective case study from September 2018 -January 2021
Both uncorrected (UCVA) and best corrected (BCVA) distance, intermediate and near vision were measured as well as, post-op refraction , . The quality of vision, and dysphotopsias like glare, and halos were evaluated. The patients' satisfaction with their IOLs was assessed using a validated questionnaire.
Three months after the Implantation of Mplus X the mean UCVA for distance was 0,78,; for intermediate 0,72;for near 0.86. BCVA was 0,83 ; The mean refraction was +0,3D .
For the second group the X the mean UCVA for distance was 0,8,; for intermediate 0,70;for near 0.79. BCVA was 0,85 ; The mean refraction was +0,25 D .None of the patients needed glasses for working on PC , The questionnaire showed ,that independence of glasses is after Mplus X higher.
The patients implanted with asymmetric multifocal hydrophobic IOLs AcunexVariomax achieved comparable visual acuity for distance and intermediate, less dysphotopsia .The visual acuity for near was better for MplusX as well the independence of the glasses. We assume ,that the material of IOL can influence the optical but also the functional result.
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On-demand

P083
MODIFIED TECHNIQUE FOR RETROPUPILLARY IRIS SUPPORTED IOL
Hazem Elnashar
Refractive
Hazem

ELNASHAR
Egypt
To asses the efficacy, stability and safety of implanting retropupillary iris supported iol using this modified technique espically in children.
memorial institute for ophthalmic research
Prospective interventional case series study of (10) eyes of 10 patients (7 males and 3 female) aged between 4-62 years with unilateral or bilateral aphakia without capsular support.Patients were done by 1 surgeon in the memorial institute for ophthamic research (MIOR) with follow up period ranges from 6 m -2years.Inclusion Criteria : patients with unilateral or bilateral aphakia without capsular support , no hoistory of uveitis.Excluison Criteria : presence of capsular support , aniridia, sever iris atrophy or iris laceration that cannot be repaired.Surgical Technique : This modified technique depending on that while I am fixating the claw in the iris ,I perforate the iris with one side of the claw to keep one side of each claw anterior to the iris, this will be more safe especially for children that this will prevent the IOL from dropping in viterous with trauma or with iris atrophy ( this technique showed in the videos of surgeries).PreOperative :full ophthalmic examination spiecally BCVA and absence of capsular support and presence of iris support.post operative: follow up the stability of the iol in its place , areas of iris atrophy and refraction of the patient .
100% of eyes showed improvement in UCVA, BCVA, stable IOL in their places (no dropped iol ,no decentered iol, no dislocted iol). UCVA : Pre-operative range from (1/60-3/60) improved post-operative to (0.3-0.7).BCVA : Pre-operative range from (0.4- 0.7) improved post-operative to ( 0.5-0.9).Refraction : no significant change in cylinder between pre and postoperatve cylinder, pre-operative sphere (+6.00 to +10.0) with significant changes post-operatively that post operatve sphere (+1.00 to + 2.00).

Retropupillary iris claw IOL is the best choice of correction of aphakia. This modification I did in the original technique will make the use of this IOL more safe especially in children even if iris atrophy occured or trauma to the eye , the part of iol in front of the iris tissue will prevent iol from dropped in the viterous.

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P084
INTRAOCULAR LENS POWER CALCULATION AFTER DOUBLE KERATOREFRACTIVE PROCEDURES - CASE REPORT
André Ferreira
Refractive
André

FERREIRA
Portugal
To report the results of challenging intraocular lens (IOL) power calculation cases in patients who received two sequential keratorefractive procedures, radial keratotomy (RK) followed by laser assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK).
Refractive Surgery Unit of Ophthalmology Department of Centro Hospitalar Universitário do Porto, Oporto, Portugal
Patient chart review
A 55-year-old woman had received refractive surgery for myopia with RK on her right eye, later enhanced by PRK more than 20 years ago. A 68-year-old man had received refractive surgery for myopia with RK on both eyes, later enhanced by LASIK on the right one more than 30 years ago. Both patients presented at our department with complains of reduced visual acuity, having a best-corrected visual acuity (BCVA) of 20/60 and 20/100, respectively. At slit-lamp examination, radial keratotomies and cortical cataracts were the main findings and the patients were proposed for cataract phacoemulsification with in-the-bag intraocular monofocal single-piece acrylic lens implantation with an A-constant of 118.7 and 119.26, respectively. The IOL power calculation was made using several formulae available at the American Society of Cataract and Refractive Surgery (ASCRS) online calculator, including IOL calculation formulas for post-LASIK/PRK condition (Shammas, Haigis-L and Barrett True K no history), formulas for post-RK condition (Double K-modified Holladay 1 based on Oculus Pentacam and IOL Master, and Barrett True K) and Kane formula. The Double K-modified Holladay and Kane formulae were found to be most accurate in predicting IOL power for the first patient while the Barrett True K for post-RK conditions was the most accurate for the male patient. After the surgery, the patients presented an BCVA of 20/30 and 20/40 with spherical equivalents of +0.125 and +0.625 diopters, respectively.
The IOL power calculation for patients with past history of keratorefractive surgery remains a challenge. The difficulty of this task is increased for patients with more than one procedure and there is still lack of evidence and consensus for these scenarios. In these two cases, no formula was found to be accurate for both patients. Thus, it is important to deal properly with preoperative patients' expectations and to inform of the risk of miscalculation.
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On-demand

P085
REPORT OF A REFRACTIVE SURGERY FELLOWSHIP IN EUROPE
Sigrid Freissinger
Refractive
Sigrid

Freissinger
Germany
To share my experience as the only European fellow of the refractive surgery fellowship from the refractive surgery alliance society (RSA). Moreover it is my goal to grow the young refractive surgery alliance in Europe bigger.
MVZ Augerlin, Augenärzte am Platz der Luftbrücke, Berlin, Germany
Ten fellows from all over the world proceed through a program as a group with regular 3 hours web meetings that provide didactic content, including lectures, case reviews, surgical videos and Journal Clubs. In these sessions the fellows are taught by renowned experts and surgeons. The task of the fellows is to prepare both for the individual courses on the basis of selected literature and books and come up with an actual case report for discussion.

The refractive surgery fellowship program of RSA brings the benefits of refractive surgery to young international ophthalmologists. Through collaboration they create an alliance of refractive surgeons based on education, research, management and patient care. As a result, refractive surgery grows by improving each member's practice.
The participation in this program represents a unique, high quality opportunity many prospective ophthalmologists can benefit from. As its first year edition, the program is still relatively unknown and exclusive. However, by making several European ophthalmologists aware of the program, refractive surgery will stay on top of best international practises.
Eposter
On-demand
On-demand

P086
LONGTERM NON-RANDOMIZED RESULTS WITH A WITH A NEW CONTINUOUS RANGE OF VISION PRESBYOPIA-CORRECTING INTRAOCULAR LENS
Nikica Gabrić
Refractive
Ivan

gabric
Croatia

To evaluate the long-term clinical outcomes and patient satisfaction with a new model of presbyopia-correcting intraocular lens (IOL) - Johnson & Johnson Synergy (ZFR00V)

Eye Clinic Svjetlost, Zagreb, Croatia
This non-randomised case series enrolled 800 eyes of 400 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). UCDVA, UCNVA, mesopic reading conditions and overall patient-reported visual performance were evaluated during a 12-month-follow up.

A total of 96.8% of patients chieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.12 ± 0.04 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.05 and 0.05 ± 0.03 logMAR. Posterior capsular opacification was observed as disturbing in 9% of patients and NdYAG laser capsulotomy was performed. Residual refractive error above 0.50 SE was observed in 17 eyes and was treated wit laser vision correction. Average residual refractive error before enhancement was 0.25 ± 0.13 sphere and 0.63 ± 0.23 cylinder.

This new presbyopia correcting IOL provided full spectacle independence in 99% patients with a limited deterioration of contrast sensitivity and patient reported dysphotopsias. We perceived this as a satisfactory outcome by the patient if proper patient selection is performed.

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On-demand

P087
EVALUATION OF A NEW BIOMETER USING TECHNOLOGY BASED ON OPTICAL LOW-COHERENCE REFLECTOMETRY COMPARED TO THE IOLMASTER 500.
Damian Garcia-Teillard
Refractive
Damian

Garcia-Teillard
Spain

To evaluate the results of optical biometry using the IOLMaster 500 andLenstar LS 900.

Axial length, keratometry and anterior chamber depth are essential parameters for
calculation IOL power [1,2]. In addition, axial length measurement is also
used for myopia progression control [3,4]. That makes biometers necessary for clinical practice.
There are different commercial instruments that provide these metrics [5-7]. In the
present work we compare parameters between two optical biometers.
IOLMaster, uses partial coherence inferometry (PCI), and Lenstar LS900,
based on optical low-coherence reflectometry (OLCR) technology. It allows, with a single shot, the measurement of nine different structures along the visual axis of the eye. It also captures nterior segment images, providing a wealth of clinical information.

The examination with both instruments was performed on 18 eyes of 9 patients. Among them we found three healthy adult patients, five healthy children patients and one refractive surgery patient (myopic LASIK). White-white parameters (WTW), keratometry (K1 and K2), axial length (AL) and anterior chamber depth (ACD) were compared.T-test or Wilcoxon test was used to compare the sample, depending on the normality of the sample.
The sample follows a normal distribution. We tested for statistically significant differences with the t-test for related samples. There are no statistically significant differences for WTW, K2 and ACD (p-value> 0.05). There are statistically significant differences for K1 and AL (p-value< 0.05). If we evaluate the values of the adult patient sample separately, there are statistically significant differences only for AL (p-value< 0.05). If we evaluate the values of the children sample, there are statistically significant differences for K1 and AL (p-value< 0.05).

Although there are statistically significant differences between the two instruments, these differences are not clinically significant.
Eposter
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On-demand

P088
CUSTOMIZED MYOPIC LASIK TREATMENTS WITH THE INNOVEYES ARTIFICIAL INTELLIGENCE SOFTWARE BY ALCON: AN OBSERVATIONAL SINGLE-ARM CONSECUTIVE CASE SERIES
Anastasios John Kanellopoulos
Refractive
Anastasios
John
Kanellopoulos
Greece
To evaluate the safety and efficacy of a novel automated ray-tracing optimization in customization of excimer ablation in myopic LASIK.
Laservision.gr Clinical and Research Institute, Athens, Greece investigator initiated study 59917561 sponsored by Alcon Greece
Observational consecutive case series; 20 consecutive myopic InnovEyes LASIK treatments (40 eyes). All qualifying cases were treated with LASIK and the InnovEyes suggested low order (refraction) and high order aberrations.The ablation profile is initially calculated based on a 3D model eye for each case. Optical coherence interferometry captures axial length data, and low and high order aberrations calculation is performed by ray-tracing based on wavefront and Scheimpflug tomography measurements, all from a single diagnostic device, InnovEyes sightmap. Visual Acuity, refractive error, keratometry, topography, high order aberrations and contrast sensitivity were evaluated, over six a month follow-up.
TBA X % of eyes gained one line of vision (UDVA post compared with CDVA pre) and X % 2 lines. Attempted vs. achieved correction was X(TBA) Diopters sphere and Xc(TBA) Diopters Cylinder. Pre- to post-operative high order aberrations average: RMSh changed from X um to X um. Contrast sensitivity changed from X(TBA) pre- to X(TBA) post-operatively.
We report safety and effectiveness preliminary outcomes with a novel excimer laser customization by ray tracing optimization, for myopic LASIK treatments, employing axial length, wavefront and corneal tomography measurements captured from one single device to produce a customized eye model reference for each case. It bears the potential advantage through total eye aberration data and ray tracing refraction calculation to offer improved and more predictable visual outcomes.
Eposter
On-demand
On-demand

P089
VISUAL OUTCOMES AFTER BILATERAL IMPLANTATION OF ACRYSOF™ IQ VIVITY™ EXTENDED VISION INTRAOCULAR LENS
Andreas Katsimpris
Refractive
Andreas

Katsimpris
Greece
To assess the visual and refractive outcomes of the non-diffractive extended depth of focus (EDOF) AcrySof ® IQ Vivity™ (Alcon, Fort Worth, TX, USA) intraocular lens (IOL) after bilateral implantation in patients undergoing phacoemulsification surgery.
In this prospective non-comparative study, 20 patients willing to undergo bilateral implantation of AcrySof ® IQ Vivity™ IOL from an experienced ophthalmic surgeon were recruited at a single center (Eye Day Clinic, Athens, Greece).
Pre- and post-operative clinical assessment of the patients included slit lamp examination, assessment of corrected distance visual acuity (CDVA) at 6 m, uncorrected distance visual acuity (UDVA) at 6 m, uncorrected intermediate visual acuity (UIVA) at 66 cm, uncorrected near visual acuity (NDVA) at 33 cm and optical biometry. Moreover, the presence of visual disturbances and the contrast sensitivity (CS) thresholds of all patients were assessed.
The mean ± standard deviation (SD) of monocular UDVA, UIVA and UNVA were 0.05 ± 0.08, 0.07 ± 0.09 and 0.23 ± 0.09 LogMAR, respectively. More specifically, 97.5%, 70% and 15% of eyes achieved UDVA, UIVA and UNVA of 20/25 or higher, while 6 patients in total reported mild glare, blurred vision, fluctuation in vision and/or depth perception difficulty. The mean ± SD of LogCS threshold was 1.68 ± 0.26.
Bilateral implantation of AcrySof ® IQ Vivity™ IOL could be a solution to patients seeking independence from optical aids. Further comparative studies are warranted to confirm our results.
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On-demand
On-demand

P090
LATE-ONSET INTERFACE FLUID SYNDROME AFTER LASER IN SITU KERATOMILEUSIS
Spyridon Koronis
Refractive
Spyridon

Koronis
Greece
To present a rare case of late-onset interface fluid syndrome (IFS).
This is a case presentation from General Hospital Papageorgiou, Thessaloniki, Greece.
A case report of IFS presenting 19 years after uneventful LASIK.
A 49-year-old woman presented with a 1-month history of gradual visual decrease in her right eye. Complete ophthalmic examination revealed mild anterior stromal edema, increased central corneal thickness and IOP with asymmetrical optic disc cupping suggesting glaucomatous optic neuropathy in her right eye. Anterior segment optical coherence tomography revealed fluid accumulation in the flap interface. Topical administration of antiglaucoma eye drops contributed to corneal edema regression and complete restoration of visual acuity, albeit with a permanent visual field defect.
IFS represents an uncommon complication that could appear years after LASIK. Early recognition and prompt therapeutic intervention contribute to the prevention of permanent optic neuropathy and optimal visual outcome.
Eposter
On-demand
On-demand

P091
VALIDATION AND CLINICAL APPLICATIONS OF DEMOCRITUS DIGITAL ACUITY READING TEST DDART
Georgios Labiris
Refractive
Georgios

Labiris
Greece
Primary objective of this study is the development and validation of the web-based Democritus Digital Acuity Reading Test – wDDART, which is based on the previously developed and validated Windows-based DDART.
The development of wDDART was carried out in the Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece, while the validation was conducted in the Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandoupolis, Greece.
This is a prospective, comparative clinic-based trial. wDDART displays sentences with text sizes from 1.3 to -0.5 logMAR for different patient-screen distances and automatically calculates: reading acuity (RA), maximum reading speed (MRS), critical print size (CPS) and reading accessibility index (ACC). It provides advanced text calibration features and monitors examination distance using computer vision techniques. For the validation, normal and low vision patients responded to wDDART and the Windows-based version DDART on the same day, at 40cm distance. wDDART-derived reading parameters were compared with the corresponding ones from DDART. Test-retest reliability of wDDART was evaluated in a 15-day time-window.
One hundred patients (normal vision group - NVG: 70 patients; low vision group - LVG: 30 patients) responded to DDART and wDDART. Non-significant differences between the two reading tests were found for all parameters in NVG and LVG. Intraclass correlation coefficients (ICCs) between the two tests demonstrated good or excellent correlation for RA, MRS, ACC and moderate correlation for CPS. Test-retest reliability was excellent for RA and ACC, while ICCs ranged between 0.715 and 0.895 for MRS and CPS.
To our knowledge, wDDART is the first validated ophthalmological reading assessment tool that is available as a web application with many novel features. Study outcomes suggest comparable validity to the DDART reading tool and high test-retest reliability, making it sufficient for clinical and research settings for the evaluation of reading acuity and reading performance in normal and low vision patients. The potential uses of wDDART as a web-based diagnostic tool are numerous, including support for screening initiatives and application to remote health facilities.
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On-demand
On-demand

P092
COMPARISON OF BIOMETRIC PARAMETERS USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY – ARGOS AND IOL MASTER 700
João Leite
Refractive
João

Leite
Portugal
Compare the biometric parameters obtained by two scanning source optical coherence tomography biometers (SS-OCT) - Argos® and IOL Master® 700.
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal.
This cross-sectional, observational and device comparison study analyzed corneal curvature (K), axial length (AL), depth of the anterior chamber (ACD), white to white (WTW) and lens thickness (LT) obtained by two biometers - Argos® and IOL Master® 700. Also, the dioptric intraocular lens (IOL) power proposed (for the Clareon® IOL model using the Barrett Universal II formula) by the two devices was evaluated. A paired t-test (p) was used to compare the parameters acquired with the two biometers; Pearson's correlation coefficient (r) was used to assess the correlation between devices. A p value< 0.05 indicates statistical significance; an r value between 0.5-1 corresponds to a high level of correlation.
A total of 315 eyes of 158 patients were successfully examined by both devices. Comparing Argos® with IOL Master® 700, the mean (SD) K was 44.13 ± 1.61 vs 44.08 ± 1.62 (p<0.001; r=0.995, p<0.01); AL was 24.23 ± 2.02 mm vs 24.39 ± 2.47 mm (p=0.155; r=0.863, p<0.01); ACD was 3.38 ± 0.44 vs 3.30 ± 0.45 (p<0.001; r=0.954, p<0.01); LT was 4.50 ± 0.53 vs 4.37 ± 0.58 (p<0.001; r=0.926, p<0.01); WTW was 11.91 ± 0.56 vs 11.93 ± 0.61 (p=0.529; r=0.462, p<0.01). In relation to the dioptric power proposed by the device, on average (SD), this power was higher in the IOL master (19.32 ± 4.68 vs 19.08 ± 5.12) (p<0.001; r=0.997, p<0.01).
Except for AL and WTW, there were statistically significant differences in the biometric parameters measured by the two biometers. However, a strong correlation between devices were found (except for the WTW). Comparing the two instruments, Argos® presents higher values in the analyzed variables, with the exception of AL and WTW. Concerning IOP power calculation, the statistical differences found may not be clinically significant.
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On-demand

P093
DIFFRACTIVE BLENDED VISION WITH A DIFFRACTIVE EDOF AND A TRIFOCAL IOL – TRIFOCAL+ VISION
David Lücht
Refractive
David

Lücht
Germany
To compare diffractive blended vision effect after cataract surgery by implantation of a diffractive EDOF intraocularlens (IOL) and a trifocal multifocal IOL (MIOL).
All surgeries were performed by one surgeon at the Breyer-Kaymak-Klabe Eye Surgery and Premium Eyes in Duesseldorf, Germany, member of the International Vision Correction Research Center (IVCRC.net).
We retrospectively analyzed diffractive blended vision effect with a diffractive EDoF IOL and trifocal MIOL (LARA /LISAtri, (CZM)) compared to classical bilateral trifocal MIOL (Panoptix (Alcon), LISAtri (CZM)). One month or more after second eye surgery, the objective is to compare binocular contrast sensitivity, binocular defocus curves and monocular and binocular halo and glare between the groups.
The LARA/LISA trifocal+ Vision strengthens LISAtri especially in the laptop distance compared to classical bilateral trifocal MIOL Implantation. This combination of EDoF and trifocal MIOL also added the distance strength, reduced halo and glare, increased contrast sensitivity in the dominant eye, but not with binocular vision.
The combination of the LARA/LISAtri further improves the visual quality. Therefore, this combination is a good option to improve e.g., the intermediate vision even more. We coined it Trifocal+ Vision. We apply the same strategy at IPCL surgery in presbyopia correction.
Eposter
On-demand
On-demand

P094
REFRACTIVE SURGERY ON DEMAND: CUSTOM-MADE TOPOGRAPHY-GUIDED ABLATION. A GOOD SOLUTION FOR THE CORRECTION OF IRREGULAR ASTIGMATISM.
Alba Marin
Refractive
Alba

Marin
Spain
To present a case of correction of irregular astigmatism by customized ablation guided by topography.
We present a case of a patient with a history of phacoemulsification + trifocal-toric IOL implantation in both eyes who remained with residual ametropia consisting in irregular astigmatism, which we decided to correct by performing a customized PRK-type ablation guided by topography.
We present a case of a patient with a history of phacoemulsification + trifocal-toric IOL implantation in both eyes who remained with residual ametropia, for which a bioptic PRK (photorefractive keratotomy) was performed in both eyes. After performing the technique, the patient reported persistence of poor visual acuity (VA) in the right eye that did not improve with optical correction (VA = 0.6). The fundus examination and the biomicroscopy exam were unremarkable. The corneal topography revealed the presence of large central irregular astigmatism and an OQAS (optical quality analysis system) test was performed, being very altered in the right eye. De-epithelialization was performed with persistence of VA = 0.6. Eventually, we decided to perform customized PRK-type ablation guided by topography for the correction of irregular astigmatism
The applied method achieved a significant reduction in the patient's irregular astigmatism, with a significant improvement in the topographic profile and achieving a VA = 1.0 with optical correction in the treated eye
Refractive surgery achieves good visual quality without optical correction in most cases. Nevertheless, conventional ablation methods have limited efficacy in irregular corneas, where custom-made topography-guided ablation has proven to be a better option; achieving a significant reduction in irregular astigmatism and an improvement in BCVA (best corrected visual acuity) with a very low complication rate.
Eposter
On-demand
On-demand

P095
HOW TO TREAT LASIK-INDUCED NEUROTROPHIC EPITHELIOPATHY. SECOND CHANCES EXIST.
Marta Isabel Martínez-Sánchez
Refractive
Marta Isabel

Martínez-Sánchez
Spain
Our purpose is to present a case report of a patient who presented a LASIK-induced neurotrophic epitheliopathy (LINE) of 3 months of evolution with no response to topical treatment, whose solution was found by surgical means; Flap lift.
Refractive Surgery Unit, ClÍnica Novovisión, Madrid, Spain.
The following is a case of a 52-year-old woman with no history of interest who underwent FemtoLASIK surgery for hyperopia correction (planned monovision, right eye dominant). The surgery was uneventful. Soon after the procedure the patient began with dry eye symptoms and severe discomfort in her left eye and keratitis punctata superficialis was easily seen at the slit lamp. Right eye showed no relevant findings. The patient was treated with topical lubricants and cyclosporine 0.05%, with no improvement observed at 3 months postop.
At this point and knowing how infrequent LINE is, it was decided to lift the left flap so that a new corneal nerve cutting could induce a more physiological corneal re-innervation. Soon after flap lifting without any laser ablation, the punctate keratitis improved and eventually disappeared, as well as the patient's symptoms.
LINE is a rare LASIK complication with several mechanisms involved in its pathogenesis: cutting of the corneal nerve endings, leading to a nerve re-growth sometimes creating an abnormal sub-basal nerve plexus that shows abnormal responses to stimuli (dysesthesia). It is a rare entity with an incidence lower than 5%, and we believe that given the fact that the chances of having an abnormal corneal nerve regeneration are small, they should be even smaller if a second chance is given.
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On-demand

P096
TREATMENT OF APHAKIC PATIENTS WITH INTRASTROMAL LENTICULE IMPLANTATION USING SMILE SURGERY.
Njomza Hima Musa
Refractive
Njomza
Hima
Musa
Albania
To investigate patient satisfaction and vision improvement by performing intrastromal fresh myopic lenticule implantation in aphakic patients using Smile.
Department of Ophthalmology
Eye Hospital
Prishtina
Kosova
Eye Hospital Pristina was performed in 13 eyes of 13 patients aged 18 and 35 years. Corrected and uncorrected visions were obtained preoperatively. When calculating diopters in aphakic patients, we determine the lenticule thickness to be added by considering variables such as AC (anterior chamber distance), K values, lens bag distance, and cornea thickness. Since there is no lens in the eye, all the task falls on the cornea.VisuMax femtosecond laser created the stromal pocket with a diameter 7.50 mm and cap thickness set to 120 μm from corneal surface and with a small opening - 3 mm superior incision at 90° and side cut angle 50°. The pocket was dissected using a blunt spatula. The lenticule was held with lenticule forceps and gently inserted into the pocket through the 3 mm superior incision.
The patients were followed up for one year. There were no complications. Postoperative uncorrected vision increased to 4 lines in 7 eyes and improved to 5 lines in 6 eyes. Patient satisfaction has increased. We think statistics and formulations for calculating implanted lenticule thickness in aphakic eyes can be easily obtained in future studies with more patients and longer follow-ups.
Intrastromal lenticule implantation is a feasible and complication-free treatment method in aphakic patients. However, more patients should be studied in order to calculate the lenticule to be implanted accurately.
Eposter
On-demand
On-demand

P097
CORRECTION OF MODERATE MYOPIA BY RELEX SMILE METHOD IN PATIENTS WITH UNSTABLE EPITHELIUM
Kim Robertovna Olga
Refractive
Kim
Robertovna
Olga
Kazakhstan
To investigate the possibility and the effectiveness of the correction moderate myopia by ReLEx SMILE method in patients with unstable epithelium.
Patient after ReLEx SMILE correction
Methods 14 patients( 28 eyes) with moderate myopia - spherical equivalent refraction was average equal to (-) 5,5 ± 0,04 D, cylinder (-) 0,75 ± 0,17 D. - underwent a standard diagnostic examination to determine the possibility of laser vision correction. During the examination, it was determined that the corneal epithelium is vulnerable to minor mechanical stress, reacting with superficial deepithelialization.
A month before the correction, all patients were forbidden to use contact lenses, drip drops and limit visual stress, especially with the use of a computer. ReLEx SMILE was performed with femtolaser VisuMax «Carl Zeiss Meditec». Observation period was 24 months.
Results. After correction UCVA at all patient was 0,95 ± 0/08 - sphere (-) 0/25 ± 0,03 D, cylinder (-) 0,25±0,07. In 4 patients, intraoperative deepithelialization occurred at the site of the laser-formed entrance during the separation of the lenticula. In 3 patients, pronounced postoperative edema was observed, which was stopped by using regenerating and osmotic eye drops for 3 days. One patient had an incomplete incision of the intracorneal lens, the operation was canceled, and six months later, the correction was performed using the FemtoLASIK method
Conclusion: The received results showed the effectiveness of ReLEx SMILE in correction moderate myopia in patients with unstable epithelium. So when the surgery choose the method of correction, it is necessary to pay attention to the state of the corneal epithelium, conduct appropriate preoperative preparation, and act with extreme caution when performing any actions with surgical instruments when separating the lenticula and forming tunnels.

Eposter
On-demand
On-demand

P098
POSTERIOR CHAMBER COLLAMER PHAKIC INTRAOCULAR LENS (ICL V4C AND V5) IN
DIFFERENT DEPTHS OF ANTERIOR CHAMBER – A COMPARATIVE STUDY
Christophe Pinto
Refractive
Christophe

Pinto
Portugal
Phakic intraocular lens implantation for the treatment of myopia is an effective and safe surgical procedure, whose complication rate may vary depending on the anatomical characteristics of the anterior segment. This study aims to evaluate the efficacy, safety and predictability of the central-hole posterior chamber collamer phakic intraocular lens implantation in two groups of patients - anterior chamber depth (ACD) below and above 3.00 mm.
Ophthalmology Department, Hospital de Braga, Braga, Portugal
This retrospective cohort study included all consecutive patients submitted to posterior chamber collamer phakic intraocular lens implantation (ICL V4C and V5) that completed a 12-month postoperative follow-up. Inclusion criteria were an age ≥ 20 years, refraction stability> 12 months, no previous eye surgeries, ACD measured from the endothelium equal ≥ 2.80 mm and minimum postoperative follow-up of 12 months. Two groups of patients were defined according to the preoperative ACD - Group 1 (ACD up to 2.99 mm) and Group 2 (ACD equal to or greater than 3.00 mm). Uncorrected (UCVA) and best-corrected (BCVA) visual acuity, subjective refraction, efficacy and safety index, predictability curve, mean endothelial density, mean static central vault and postoperative complications were evaluated preoperatively and at 12 months postoperatively.
A total of 558 eyes from 298 patients were evaluated - 111 eyes (19.9%) in group 1 (mean ACD 2.91 ± 0.06 mm) and 447 eyes (80.1%) in group 2 (mean ACD 3.31 ± 0.23 mm). The preoperative value of spherical equivalent (SE) to be treated was -9.40 ± 3.17 in group 1 and -8.02 ± 3.48 (p<0.001) in group 2. In group 1, 80.7% of the implanted lenses were 12.60 mm in diameter, while in group 2, 32.3% were 12.60 mm and 58.4% were 13.20 mm. At 12-months postoperatively, the mean postoperative SE was identical in both groups (p=0.50). The efficacy index was similar in both groups (p=0.26); the safety index was higher in group 1 (p=0.03). The mean central vault at 12 months was significantly lower in group 1 (252 ± 154 um) than in group 2 (431 ± 220 um) (p<0.001). There were no significant differences in endothelial cell loss at 12 months or in the rate of complications observed (p=0.31 and p=0.77, respectively).

Posterior chamber collamer phakic intraocular lens implantation is an effective and safe procedure in narrow anterior chambers (2.80 to 3.00 mm), with visual and refractive results and complication rate identical to those obtained in chambers greater than 3.00 mm.
Eposter
On-demand
On-demand

P099
CHARACTERIZATION OF DAILY VISUAL HABITS OF A SAMPLE OF CATARACT REFRACTIVE SURGERY CANDIDATES.
Filomena J Ribeiro
Refractive
Filomena
J
Ribeiro
Portugal
To evaluate and report the visual habits and requirements of a sample of Cataract refractive candidates using an advanced sensor.
Hospital da Luz, Lisboa, Portugal
Transversal study collecting clinical data from 40 patients with mean age of 61.0 years (43-80 years). A complete ophthalmological examination was performed in all patients including visual, refractive, an ocular biometric analysis. Furthermore, patients were instructed about the use of the Vivior Monitor system (Vivior AG, Zürich, Switzerland), This device was worn for a period of at least 36 hours or more. The data collected was transferred to a database and analyzed.
Mean percentages of time dedicated to distance, intermediate and near vision were 27.25±11.93% (5-65%), 30.23±9.36% (12-50%), and 42.53±14.96% (13-78%), respectively. Mean percentages of time performing activities under photopic, mesopic and scotopic conditions were 37.08±23.20% (5-87%), 33.65±13.84% (6-67%), and 29.28±17.03% (4-65%). Likewise, the percentage of time using mesopic conditions was correlated with the time associated to distance (r=0.384, p=0.015) and near vision (r=-0.339, p=0.032).
Distance and illumination conditions used to perform different daily life visual activities vary significantly among presbyopes, with a trend to the dedication of more time to intermediate and near visual activities performed under photopic and mesopic conditions.
Eposter
On-demand
On-demand

P100
TORIC PHAKIC VERSUS BIOPTICS FOR MANAGEMENT OF COMPOUND MYOPIA AND ASTIGMATISM
Hams Samy
Refractive
Hams

SAMY
Egypt
To compare the refractive outcomes after toric phakic IOL implantation with bioptics to manage myopia and astigmatism.
A prospective non-randomized comparative study.
Included in this study are patients with compound myopia and astigmatism asking for refractive surgery. Inclusion criteria included myopia of 7D or more and astigmatism of more than 1D. Two groups were established; group A (phakic toric IOL) and B (bioptics).
Eyes with irregular corneal astigmatism and endothelial cell abnormalities based on specular microscopy were excluded.
Group A was assigned to Toric ICL. Group B was subjected to a two-step procedure; the first step included Femto flap creation (100 microns thickness) without lifting, followed by phakic (ICL or VeriFlex) IOL implantation on the same day. The second step was set at least two weeks after phakic lens implantation and included flap lifting and excimer laser ablation to correct residual astigmatism and myopia if present.
Postoperative examinations were scheduled on days 1, 2 wks, 4 wks, and 8 wks.
Group A and B comprised 34 and 52 eyes, respectively. Mean age in both groups showed no statistically significant difference.
At the final postoperative visit, 29% of eyes in group A vs. 96% of eyes in group B achieved a refractive cylinder of 0.5D or less.
The mean refractive astigmatism in group B (0.10D @105±0.29D) was significantly less than group A (0.34D@97±0.68D). Prediction error was significantly higher in group A compared to group B (0.49D@95±0.68D vs. 0.25D@96±0.29D. Ocular coma, trefoil, and spherical aberrations were comparable between both groups. Group A and B comprised 34 and 52 eyes, respectively. Mean age in both groups showed no statistically significant difference. At the final postoperative visit, 29% of eyes in group A vs. 96% of eyes in group B achieved a refractive cylinder of 0.5D or less.The mean refractive astigmatism in group B (0.10D @105±0.29D) was significantly less than group A (0.34D@97±0.68D). Prediction error was significantly higher in group A compared to group B (0.49D@95±0.68D vs. 0.25D@96±0.29D. Ocular coma, trefoil, and spherical aberrations were comparable between both groups.

Bioptics might result in more precise refractive outcomes than phakic toric IOL in treating compound myopia and astigmatism. Flap creation by femtosecond laser allows flap lifting later on, yet if the flap was not lifted during the primary procedure. Added to this, the ease of correction of future ametropia by flap lifting.
Eposter
On-demand
On-demand

P101
COMPARING THE CLINICAL OUTCOME OF TRANS-
PHOTOREFRACTIVE KERATECTOMY AND TRADITIONAL PHOTOREFRACTIVE KERATECTOMY IN CORRECTION OF MODERATE MYOPIA: A RANDOMIZED CLINICAL TRIAL
Nader Nassiri
Refractive
Kourosh

Sheibani
Iran, Islamic Republic Of
To compare the clinical outcome of transepithelial photorefractive keratectomy (tPRK) and traditional PRK techniques.
Vanak Ophthalmology Clinic, Tehran, Iran
This randomized clinical trial included 120 eyes from 60 consecutive patients with moderate myopia referred to our clinic, in year 2020. Patients were randomly assigned to be operated either using tPRK method (using Wong baker scale) or traditional PRK method.
The improvement in patients' visual acuity (UCVA, BCVA) one and three months post surgery was statistically significant (p< 0.001 in both groups). The mean UCVA improvement was significantly higher in tPRK group (p = 0.031), but this difference was not statistically significant regarding the BCVA improvement. The mean Spherical Equivalent change in the PRK group in the one-month follow-up was 3.68 ± 1.00 and in the tPRK group it was 4.12 ± 0.92, indicating a better improvement in the tPRK group (p = 0.012). The mean haze in patients undergoing tPRK was significantly lower than the PRK group one moth postoperatively (p< 0.001). Also the patients undergoing tPRK experienced significantly less pain (p = 0.027) and discomfort (p< 0.001) compared to the PRK group. There was no difference between the two groups regarding intraocular pressure after surgery.

The results of our study showed the superiority of the tPRK method over the PRK in some parameters when correcting moderate myopia.
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P102
STROMAL BED PASSIVE DRAINAGE USING FLUTE NEEDLE DURING LASIK
Alaa Abdalsadek Ahmed Sinjab
Refractive
Alaa
Abdalsadek Ahmed
Sinjab
Egypt
To detect safety and efficacy of flute needle passive drainage during lasik
Future center for corneal and refractive surgeries, Sohag, Egypt
Group A (study group): 30 eyes, at the end of surgery and after repositioning of the corneal flap, flute needle was used at the gutter to passively drain any residual fluid from the interface.
Group B(control group): 70 eyes, subjected to conventional lasik procedure.
Outcomes: 1ry: flap apposition (clinically and by anterior segment OCT) at 2nd and 7th days postoperatively. 2ry: BCVA.
Group A: all eyes showed perfect flap apposition.
Group B: one eye had macrostriae necessitating repositioning, 3 eyes had microstriae. 7 eyes showed small film of fluid in the interface by OCT in the 2nd postoperative day which disappear within a week.
No statistically sighinficant difference in BCVA between both groups.
Flute needle passive drainage during lasik is a safe and effective method for better flap apposition and healing.
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P103
LONG TERM OUTCOMES OF BOWMAN’S MEMBRANE RELAXATION FOR ENHANCEMENT OF FEMTOSECOND INTRASTROMAL LENTICULE IMPLANTATION (FILI) PERFORMED FOR THE MANAGEMENT OF HIGH HYPEROPIA
Supriya Samak Sriganesh
Refractive
Supriya
Samak
Sriganesh
India
To evaluate, retrospectively, the feasibility and report long-term outcomes with Bowman's membrane relaxation (BMR), for enhancing the residual refractive error following Femtosecond intrastromal lenticule implantation (FILI).

Nethradhama Superspecialty Eye Hospital, Bangalore

BMR was performed using a Hessburg-Barron trephine to create a circular incision into the Bowman's Membrane and anterior corneal fibres up to the depth of around 120-130 µm. Post enhancement clinical outcomes were analysed at a mean period of 36 months (range 14-57 months).
our eyes of 3 patients ( mean age 29 years), underwent enhancement with BMR for a significant residual refractive error of + 2.25 D SE following FILI for high hyperopia (mean SE +7.00 D). Post BMR, the residual refraction reduced to +0.31 D, resulting in improvement in UDVA from 0.55 to 0.33 LogMAR. The mean front keratometry (Pentacam HR) increased from 46.2 D to 49.3 D, and the mean back keratometry increased from -5.9 to -6.3D following BMR, the latter returning to the baseline (pre-FILI) value of -6.3 D. An increase in Q-value with a corresponding increase in higher order aberrations(HOA) was observed. Corneal biomechanics (Corvis-ST) indicated reduction of stiffness and other parameters post-enhancement. No intra or post-operative complications were noted.
Bowman's Membrane Relaxation (BMR) may be a safe, simple and effective technique for enhancement of residual hyperopia following tissue addition techniques such as FILI. There could be an evidence that BMR may reverse the posterior curvature changes negating the steepening effect of the anterior cornea following tissue addition, potentially aiding in the enhancement.
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P104
EFFECTIVE SMALL INCISION LENTICULE EXTRACTION (SMILE ) TREATMENT OF RESIDUAL MYOPIC REFRACTIVE ERRORS AT PSEUDOPHAKIC PATIENTS
Anita Syla Lokaj
Refractive
Anita

Syla Lokaj
Albania
Purpose: The aim of this study is to improve visual acuity in pseudophacik (IOL) patients who have residual myopic refraction after 3 months of surgery using SMILE module.
Eye Hospital St'Selim Berisha' nn, Prishtine,Kosova Postal Code: 10000
Clinical trial Reg: NCT04693663
Methods :208 eyes of 150 consecutive patients who underwent pseudophakic (IOL) implantation such as trifocal, multifocal, and monofocal were included in this retrospective study. All residual myopic eyes underwent SMILE surgery
Result: The age of patients was between 53 and 82 years, and the pre-operative residual myopic refraction was between -0.75 D and -5.50D.Two hundred eight eyes were followed after SMILE for two years.
There was a significant increase in UDVA(uncorrected visual acuity) from (0.51±0.18 to 0.01±0.02)LogMAR p<0.001). Moreover, patients satisfaction improved.
Conclussion: Smile surgery is the most reliable method in the treatment of pseudophakic residual refractions. It also increases patient satisfaction and vision in a short time.
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P105
DIGITAL EYE STRAIN AND ITS ASSOCIATED FACTORS IN CHILDREN DURING THE COVID-19 PANDEMIC
Busra Yilmaz Tugan
Refractive
Busra

Yilmaz Tugan
Turkey
This study was undertaken to identify the prevelance of symptoms related to the use of display devices and contributing factors in children engaged in distance learning during the COVID-19 pandemic.
An online electronic survey
The form was prepared using Google Forms (Alphabet Co., Mountain View, CA) and sent to parents of children under the age of 18 years engaged in distance learning during the COVID-19 pandemic. The types of display devices children use, how often such devices are used, the symptoms of digital eye strain, and the severity and frequency of the symptoms were recorded, and the associations between the factors were analyzed.
A total of 692 participants were included. The mean age of the children was 9.72 ± 3.02 years. The most common display devices used were personal computers (n = 435, 61.7%) for online classes and smartphones (n = 400, 57.8%) for non-academic purposes. The mean duration of display device use was 71.1 ± 36.02 minutes without a break and 7.02 ± 4.55 hours per day. The most common reported symptom was headache (n = 361, 52.2%). Of the participants, 48.2% (n = 332) reported experiencing 3 or more symptoms. The multivariate analysis detected that being female (P = 0.005) and older age (P = 0.001) were independent risk factors for experiencing 3 or more symptoms.
The increasing use of digital devices by children is exacerbating the problem of digital eyestrain in children as a side effect of online learning. Public awareness should be improved.
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P106
IMAGE ANALYSIS BASED ON A NOVEL APPROACH OF ARTIFICIAL INTELLIGENCE FOR PREDICTION OF KERATOCONUS
Soheil Adib-Moghaddam
Cornea
Soheil

Adib-Moghaddam
Iran, Islamic Republic Of
Using a modeling system for early keratoconus diagnosis, one of the most challenging problems in ophthalmology, would provide a powerful tool for eye care professionals. We aimed to develop a novel model based on a chaotic system to extract the non-constant coefficients in an individual manner in every single case of keratoconus.
Bina Eye Hospital, Tehran, Iran.
Corneal properties were modeled using SIRIUS images. The designed model was implemented on two subgroups with 65 healthy cases and 32 keratoconus patients who participate in our study are between 23 to 74 years old (54 men and 43 women). To examine the accuracy of results, all cases are set into two subgroups (subgroup 1 and 2). The designed model was done in each subgroup and gathered data was analyzed.
The results of model analysis based on the chaotic system for divided subgroups in SIRIUS images reveal that significant sensitivity and specificity. Data results are 88% and 92% sensitivity for subgroup 1 and subgroup 2 respectively and specificity is 90% and 96% for subcategory 1 and 2 respectively (subgroup 1 p-value: 0.028 and subgroup 2 p-value:0.025).
In this study, Keratoconus diagnosis with the help of a chaotic system with the characteristic of being exclusive to each patient is introduced by the (Iran)model. Promising results of accuracy and repeatability represent a novel approach in the field of keratoconus diagnosis.
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P107
THE APPLE ON MY EYE – A CASE OF CUSTARD APPLE INDUCED TOXIC KERATOCONJUNCTIVITIS.
Edward Patrick Ahern
Cornea
Edward
Patrick
AHERN
Ireland
To describe a case of bilateral Annona squamosa (custard apple) induced ocular toxicity and to review the relevant literature.
Department of Ophthalmology, Cork University Hospital, Ireland.
Case report of a 55 year old female who presented with a 1 day history of severe bilateral eye pain and redness. She reported use of a home made exfoliating face cream partly consisting of ground custard apple seed. Exam revealed bilateral diffuse conjunctival injection, 80% and 70% corneal epithelial defect in the right and left eye respectively with no limbal ischemia. Considering the atypical presentation, a literature review was immediately conducted and confirmed the principal cause of her ocular toxicity as the ground seeds.
Targeted treatment for custard apple toxicity was commenced with vigilant avoidance of topical steroid. Treatment constituted immediate copious irrigation, inpatient management with intensive hourly lubricants (trehalose, sodium hyaluronate), preservative free chloramphenicol QDS and cycloplopentolate 1% TDS with eye padding between drops. Within 48 hours the patient symptomatically improved. Re-epithelialisation occurred with no infiltrates or scarring and conjunctivae were white. At follow up 2 weeks later the patient was off all drops, asymptomatic and was discharged. To our knowledge this is the first reported case of custard apple seed ocular toxicity described in Europe. The medicinal qualities of which are valued in traditional Indian medicine where the sparse reports of ocular side effects originate.
There is importance in patient education regarding traditional herbal remedies and their potential for ocular toxicity. Clinicians must be aware of custard apples as a rare cause of ocular toxicity. The use of steroids in such cases is associated with worse outcomes including vision threatening microbial keratitis and need for penetrating keratoplasty. Although the current literature is limited, management with avoidance of topical steroids led to an excellent outcome on our case consistent with what has been described previously.
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P108
NEUROTROPHIC ULCER POST-SURGERY FOR TRIGEMINAL NEURALGIA: A CASE REPORT
Jihane Ait Elhaj
Cornea
Jihane

AIT ELHAJ
Morocco
Neurotrophic keratopathy is partial or complete denervation of the cornea from various origins. It causes corneal sensitivity disorders and chronic degenerative damage to the corneal epithelium. It can be complicated by chronic ulcers which can go as far as perforation. It is a relatively rare pathology and which presents a problem of management. The aim of this work is to illustrate the clinical, therapeutic and prognostic aspect of neurotrophic ulcers through a case report
ophthalmology department, hospital August 20, casablanca university hospital
this is a 57-year-old female patient, followed for trigeminal neuralgia, operated 6 months ago by thermo-coagulation of Gasser's gg in neurosurgery. she presented to the emergency room with a painless red eye and reduced visual acuity in her left eye that had progressed for 20 days the patient was placed under eye wash, autologous serum, wetting agents, a therapeutic soft lens with a daily monitoring the evolution was marked on D5 of the treatment by a start of re-epithelialization on D32 of treatment with total re-epithelialization, the patient retained para-axial corneal opacity as sequelae with visual acuity corrected to 1/10.
Neurotophic corneal ulcers is a serious entity. They can endanger the anatomical integrity of the ocular surface and the transparency of the cornea be at the origin of a deep and lasting decline in VA. Trigeminal neuralgia surgery is a classic etiology of neurotrophic ulcers but other etiologies are described as V palsy (aneurysm, post-traumatic, post-surgical, tumor, hereditary ...), Infectious (Herpes simplex, Herpes ZONA), Burns, diabetes, System Diseases... They are manifested by reduced visual acuity, conjunctival hyperemia, lacrimation, and abolished corneal sensitivity. Neurotrophic corneal ulcers are staged according to the MACKIE Staging (stage 1: superficial punctate keratitis, stage 2: Epithelial ulceration, stromal edema, tyndall in anterior chamber, stage 3: stromal damage, perforation). Treatment of neurotrophic ulcers is nonspecific and should be prompt and aggressive. Wetting agents are indicated whatever the stage. As well as the avoidance of eye drops with preservatives and local corticosteroid therapy. Autologous serum, Therapeutic soft lens, scleral glass, Amniotic membrane are also prescribed according to the indication.
The management of corneal ulcers is difficult. The clinical approach should include an accurate history and a complete clinical examination, during which the assessment of sensitivity is paramount. The priority is to exclude an infectious pathology. The treatment must be rapid and effective because the integrity of the globe is threatened.

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P109
CORNEAL DAMAGE DURING EYE TRAUMA
Hamza Alaoui
Cornea
Hamza

Alaoui
Morocco
Eye trauma occupies an important place in ophthalmological emergencies. Occupational eye injuries constitute 53 to 70% of overall eye injuries.
Early management of these patients minimizes the severity of complications , consequences , and their socio-economic impact.
The aim of this work is to explore the main causes of occupational eye injuries in Casablanca in order to formulate practical recommendations for effective primary prevention according to the professions.
ophthalmology department; August 20th,1953 hospital Ibn Rochd University Hospital Center Faculty of Medicine and Pharmacy Casablanca Hassan II University (Morocco)
Our work is a retrospective study of 6738 patients with ocular trauma from January 2021 to June 2021 in the emergency department. We analyzed the parameters related to professional eye trauma , and collected data concerning the identification of the patient, the type of accident, the causes and circumstances of the accident , the wearing or not of protective equipment , the employee's state of consciousness at the time of the accident , the nature of the impacting agent, the frequency of accidents professionals according to the type of activity, the prevention method in the company, the staff awareness, and the existence of other employees exposed to the sameworking conditions.
We have identified 5,016 occupational eye trauma, which represents 69% of all eye injuries.
Construction workers had the highest accident rate at 39.5%, followed by workers in the metallurgy (21.4%) and lumber (5.6%) sectors. The most common process leading to an accident was grinding (19.3% of cases) and the traumatic agents are metallic foreign bodies (64.7%). Concerning the site of the injuries, there was a predominance of corneal locations (84.9%) dominated by corneal erosions post-ablation of foreign bodies (41.8%). We recorded a high rate of lack of awareness (65.8%).
Safety at work and quality of work are goals of equal value for a company. Despite numerous efforts over the past century or so, our study shows that 73% of occupational eye accidents are due to negligence: lack of awareness, wearing of poorly adapted protective glasses or even the lack of wearing personal protective equipment. When we combine this with the shortcomings observed in the organization of workstations, it becomes obvious that particular emphasis must be placed on primary prevention.
We offer practical and ambitious recommendations. Of course, zero risk does not exist, but we are convinced that the rigorous application of these recommendations would bring us closer to it for the good of the eyes; our most precious sensory organs.
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P110
VISUAL REHABILITATION OF POST-TRAUMATIC IRREGULAR ASTIGMATISM
Hamza Alaoui
Cornea
Hamza

Alaoui
Morocco
Corneal irregularity, whether primary (keratoconus) or, as here secondary to corneal wound, is a source of qualitative or even quantitative visual deficits.
The corneal topography plays a crucial role in guiding the adaptation to a rigid lens, the only one capable of effectively and safely erasing major irregularities of the anterior corneal diopter.
In giant corneal astigmatisms, semi-scleral lenses can represent a temporary solution while waiting for the time of the transplant, or even an alternative to the transplant if the result is satisfactory.
ophthalmology department; August 20th,1953 hospital Ibn Rochd University Hospital Center Faculty of Medicine and Pharmacy Casablanca Hassan II University (Morocco)
Our patient was received in the emergency in March 2021 for transfixing corneal wounds of the left eye with ruptured post traumatic cataract, following a self-trauma by a scalpel.
The emergency care was carried out in two stages:
1st step: Closure of the wound after iris reintegration and careful washing of the anterior chamber.
2nd step: Surgery of the ruptured cataract with rupture of the capsular plane, by simple irrigation-suction and implantation in the SULCUS.
Parameterization of the rigid gas permeable lenses (RGP):
Neutralization of irregular and major asymmetric corneal astigmatism can only be done by an RGP with Large diameter: to improve comfort and large optical area to optimize optical benefit.
Causes of post traumatic corneal irregularity : Healing of the southern stromal incision
or linked to the destructuring effect of the deep southern incision on the stromal architecture.
In irregular corneas, the scleral lens can restore a uniform surface and thus correct vision by creating a uniform surface with a better success rate than with glasses.

This unusual case illustrates the interest and the rules for adapting post-traumatic irregular corneas by scleral glasses.
And above all to never lose hope in the quest for visual perfection by non-surgical means, especially in our Moroccan context where the corneal transplant applicant is faced with long waiting lists.
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P111
MACULAR PHOTOTOXICITY FOLLOWING CORNEAL COLLAGEN CROSS-LINKING IN A PATIENT WITH KERATOCONUS
Mohammed Ahmed Alfayyadh
Cornea
Mohammed
Ahmed
Alfayyadh
Saudi Arabia
Keratoconus is a progressive degenerative corneal disease of variable severity. Its management includes medical and surgical treatment. Corneal collagen cross-linking is being increasingly used to stabilize the condition. Macular phototoxicity is a well-known side effect of light exposure; however, its incidence after treatment with riboflavin and ultraviolet light is unknown. We report the clinical features of a patient with macular phototoxicity after ultraviolet A exposure and describe the structural and angiographic retinal changes observed in this patient.
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Patient, clinical findings, and diagnosis: A 37-year-old man with keratoconus underwent corneal refractive surgery (topography-guided custom ablation with accelerated and high-fluence corneal collagen cross-linking). Postoperatively, he had decreased vision in the operated eye. Ophthalmoscopy, spectral-domain optical coherence tomography, and fluorescein angiography revealed retinal pigment epithelial changes, ellipsoid zone disruption, and window defects, respectively. The patient was diagnosed with macular phototoxicity. His corrected distance visual acuity stabilized at 20/100 after two and a half years.
-
Macular phototoxicity may occur after ultraviolet A exposure during corneal collagen cross-linking. The use of accelerated and high-fluence protocols might have contributed to its occurrence in our patient.
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P112
THE EFFECT OF THE PLASTIC VERSUS GLASS STAINING VESSEL DURING DMEK GRAFT PREPARATION ON THE RATE OF ENDOTHELIAL CELL LOSS
Britta Gustavson
Cornea
Abdullah

Al-Kaabi
Canada
Endothelial cell loss (ECL) during corneal graft preparation affects graft survival and the re-grafting rates. During Descemet membrane endothelial keratoplasty (DMEK) donor tissue is incubated in Trypan blue ophthalmic solution, typically in either a glass or plastic vessel. DMEK grafts are exquisitely sensitive, with ECL documented from any form of touch. Furthermore, cellular damage of cells due to oxidative stress and mitochondrial depolarization secondary to exposure to micro-plastic chemicals has been established in the literature. This study aimed to investigate how the material in contact with DMEK tissue during staining impacts the rate of ECL to better inform surgeons and material scientists when choosing materials for DMEK.
This study was conducted at Hôpital Maisonneuve-Rosemont (HMR) and the Jewish General Hospital (JGH), Montréal, Canada. This study was approved by the CIUSSS-EMTL and the JGH Ethics Boards.
Data were collected from all patients who underwent DMEK surgery by the same surgeon (Dr.J. Choremis) between January 2019 and June 2020 at two sites. Patients operated at JGH constituted the plastic group whereas patients operated at HMR were the glass group. Patients with ocular co-morbidities and patients who passed away within 6 months of surgery were excluded from all analyses. The primary endpoints were the rate of ECL, absolute ECL, and percentage ECL, at 12-30 months. The secondary endpoints were re-bubbling and graft failure rates, at ≥6 months. ECL was the difference between pre and post-operative specular microscopy counts. The unpaired student's t-test, chi-squared test, and ANCOVA were used with a power of 0.8 and a significance of 0.05.
The results demonstrate that there is a significant difference between plastic and glass groups in the rate of ECL at 12-30 months post-DMEK, with a smaller rate of loss in the plastic group (2.49% vs. 3.37% ECL/month, p=0.010). Future data beyond 30 months will help determine if these differences have clinically meaningful effect for patients and the need for re-grafting. There were no significant differences in the other endpoints and no confounding variables. In addition, there were no significant differences between the rates of re-bubbling or of graft failure at 6-30 months.
These data demonstrate that the choice of material used as a staining vessel for DMEK has a significant impact on the rate of ECL. This has practical implications for the choice of vessel and the development of new technologies for DMEK surgeries. With further investigation, confirmation of the superiority or, with targeted samples, the non-inferiority of plastic will have substantial impact on DMEK materials development. Of note, the target sample size was not met therefore the power of these conclusions may be reduced. Nevertheless, these data support further investigation into the effect of synthetic materials on ECL in order to optimize surgical procedures leading to a successful DMEK surgery.
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P113
LATE SPONTANEOUS REATTACHMENT OF THE GRAFT AFTER A DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK).
German Allendes-Urquiza
Cornea
German

Allendes-Urquiza
Spain
To present a case of late spontaneous reattachment of the graft after a DMEK.
Cornea and Anterior Segment, Hospital Universitario PrÍncipe de Asturias, Alcalá de Henares, Madrid, Spain.
A 78-year-old woman with corneal decompensation after cataract surgery in the right eye (RE) is admitted for a DMEK. The surgery did not present complications, the donor graft was fully attached and well centered. The first day after surgery examination revealed a well-positioned transplant, with a clear center and no signs of detachment under the gas bubble. Three days after surgery, there was a partial detachment (less than 10% of the graft surface) in the temporal zone, with sub-epithelial edema. The gas bubble was at 25% size. Treatment with topical corticosteroids and antibiotics continued. After a week, the visual acuity (VA) of the RE was 20/200, so a macular and anterior segment optical coherence tomography (OCT) was performed. It showed cystoid macular edema (CME) and the graft had a central detachment with peripheric attachment. One dose of intravitreal Ranibizumab was administered, presenting VA of 20/40 three weeks after the injection. New OCTs were performed, showing partial re-attachment of the donor graft, with distances of 353 to 74 µm from stroma to the graft in 4 months
We present a case in which after DMEK surgery, the patient presented a graft detachment. The possibility of reverse placement of the endothelium was considered, suspecting an upside-down of the graft due to the clinical characteristics, although it did not present corneal alterations. Surgical correction was not performed due to the development of CME. After several months of treatment and a decrease in CME, it was observed that the graft increased its adhesion spontaneously.
DMEK offers the opportunity for visual gain in cases of endothelial dysfunction. It is used to treat corneal disorders. Like other surgeries, some factors may affect negatively the results. Graft detachment may be the most frequent complication after DMEK, occurring in up to 82% of cases and this can be because of different causes. One of these is that the edges of the graft fold 'inward' or curl in a roll toward the patient´s posterior stroma underneath the rest of the donor membrane. Other causes are insufficient support from the air bubble after surgery, mistakenly implanting the graft upside down, use of plastic materials during surgery, and stromal irregularities underneath the site of the main incision. Awaiting spontaneous clearance, or surgical intervention like air/gas re-injection inside the anterior chamber (graft re-bubbling) or re-orientation of an upside-down or can be considered if there is no resolution of the detachment. Another complication can be CME, with an incidence after DMEK of 7 to 13.8%.
There are no reports of spontaneous reinsertion of the DMEK graft after so many month and with this level of detachment, so we consider it convenient to disclose this clinical case.

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P114
OUR EXPERIENCE WITH BOSTON KERATOPROSTHESIS, PATIENTS AND OUTCOMES
Mousa Almadani
Cornea
Mousa

Almadani
Jordan
We aim to describe the outcomes of a retrospective case-series using Boston keratoprosthesis type 1 for the management of eyes with end stage corneal blindness at the Royal Medical Services of Jordan.
Eleven eyes of eleven patients with different corneal diseases were included in this case-series between the periods of 2013-2016. Majority (90%) were men and the population mean age was (52.5) years.
Patients included in the study were patients with multiple grafts failure in 25% of patients, primary Keratoprosthesis (Kpro) for severe vascularized opaque corneas in 37.5% of patients, chemical injury in 12.5% of patients and disorganized anterior segment after severe infectious keratitis in 25% of patients. Mean follow-up time was 12.75 months
We found that 25% of patients presented with preoperative visual acuity of hand motion, while 6 patients had a preoperative visual acuity of perception of light vision. Nonetheless, all patients showed postoperative improvement in their visual acuity. 37.5% of patients had a visual acuity of 0.5, 25% of patients had a visual acuity of 0.7, 12.5% of patients had a visual acuity of 0.4, 12.5% of patients had a visual acuity of 0.1 and 12.5% of patient had a visual acuity of counting fingers over three meters when measured one-month post op.
Boston Kpro is an effective way of restoring vision in patients with end stage corneal blindness not amenable to conventional keratoplasty. Good patient selection, close follow-up and early addressing of complications is very effective in increasing the retention rate of the prosthesis and maintaining useful vision
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P115
UNUSUAL HERPES: A DIFFERENT KIND OF PRESENTATION
Francisco Alves
Cornea
Francisco

ALVES
Portugal
Herpes simplex infection is ubiquitous in humans; at autopsy, nearly 100% of persons older than 60 years are found to harbor HSV. It has been estimated that one-third of the world population experiences recurrent infection. HSV infections are, therefore, a large and worldwide public health problem. The main purpose of our work is to enphasize this problem, and to alert Ophthalmologists that there are some kinds of a not so typical presentation, which we all must be aware.
Instituto de Oftalmologia Dr. Gama Pinto (IOGP)
Case report from one of our patients with a primary ocular HSV infection with an unusual form of presentation.
Case report: Male, 35 years. At the first clinical appointment, the patient reffered on the right eye a foreign-body sensation, light sensivity, redness, and blurred vision. The patient had no significant past medical history. Visual acuity of 10/10 (by the Snellen acuity chart) in each eye. Intraocular Pressure of 13/12 mmHg in each eye. At observation, the patient presented vesicles on the skin near the right eye, a fibrovascular proliferation (the unusual form of presentation we would like to point out and show) from the conjunctiva to the Cornea and, with fluoresceÍne staining of the right eye, dendritic epithelial keratitis. There were no alterations at the ocular fundus. With the diagnosis of primary ocular HSV infection in mind, the patient started topical Valganciclovir and ocular lubrication. About 3 days later, the epithelial keratitis was already resolved, the fibrovascular proliferation was recceding, and one week later, it was already gone.
HSV infections are very prevalent, and, as Ophthalmologists, we must all be aware of ocular manifestations, as there are many (to periocular vesicles to dendritic epithelial keratitis). Sometimes, some unusual forms may appear (as the one we described), and we must stay alert to this, so we can treat the patients on time, and in the best possible way.
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P116
EXPLORING THE EFFECT OF COVID LOCKDOWN ON MICROBIAL KERATITIS PATTERNS
Diandra Monique Antunes
Cornea
Diandra
Monique
Antunes
United Kingdom
To compare the rates of presentation of microbial keratitis during the COVID-19 lockdown with previous years and to compare the causative organisms cultured from corneal scrapings over these periods along with their sensitivities.
All results were taken from corneal scrapings done within the Ophthalmology Department at Ipswich Hospital, a large district general hospital in the United Kingdom.
Retrospective analysis from 2018 to 2021 of corneal scrapings taken from cases of microbial keratitis at Ipswich Hospital was done. Comparison of the number of cases, specific organisms grown and reporting of antibiotic sensitivities of each was done through review of clinical notes and microbiology results.
There was a fourfold decrease in presentations of microbial keratitis during the national lockdown from March to May 2020 compared with the previous year, however the total number of annual presentations remained constant. There was a 133% increase in the number of different pathologic organisms cultured following the lockdown period compared with other years. This returned to pre-lockdown levels over the following year. A 50% increase in the incidence of resistant organisms was also noted over the four years investigated.
The increase in microorganisms cultured following the lockdown period may have been the result of delayed presentation and therefore timely medical treatment. This highlights the importance of ensuring patients are aware of early warning signs and that healthcare practitioners maintain a low threshold for referring patients with suspected microbial keratitis in order to avoid increases in pathogenic organisms, which may further potentiate cases of antimicrobial resistance in the future.
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P117
BILATERAL IRREVERSIBLE CORNEAL OEDEMA SECONDARY TO AMANTADINE TOXICITY IN A PATIENT WITH MULTIPLE SCLEROSIS
Zahra Ashena
Cornea
Zahra

ASHENA
United Kingdom
Ocular toxicity of some systemic medications is well recognised, hence regular ophthalmic examination is arranged for patients. With regards to Amantadine, the literature reports evolution of corneal oedema two months to a few years after starting this medicine, with spontaneous resolution of oedema in short term intake and irreversible oedema in long-term use. However, its toxicity is yet unknown to most ophthalmologists and neurologists. To highlight the drastic impact of this medicine on the cornea and consequently the vision of these patients we report a case of bilateral irreversible corneal oedema in a young patient with multiple sclerosis (MS).
Queen's Hospital, London, United Kingdom
A 36-year-old wheelchair bound Caucasian female, known with MS and suspect neuromyelitis optica (NMO) presented to the eye casualty with bilateral gradual deterioration of vision over six weeks. Her past ophthalmic history showed a few episodes of optic neuritis, affecting both eyes in the past with final best corrected visual acuity (BCVA) of 0.65 LogMar in the right eye and 0.55 LogMar in the left eye. At presentation, BCVA was 1.25 LogMar in the right eye and 1.20 LogMar in the left eye with no improvement with pinhole. Examination showed bilateral diffuse corneal oedema with multiple Descemet folds and no evidence of endothelial guttata. Specular microscopy showed 625 and 680 cells/mm2 in the right and left eye with central corneal thickness of 835µ and 796µ respectively. The eyes were quiet with no anterior chamber activity and normal intraocular pressure. The corneal sensation was completely normal and there was no history of herpes simplex keratitis in the past. Review of her medications revealed that she has been on Amantadine 100mg capsules once a day to treat the MS-related fatigue symptoms for 10 years and literature review confirmed the adverse effect of this medicine on the corneal endothelial cells. Amantadine was discontinued and she was treated with topical sodium chloride 5% eye drops and Aciclovir 400mg tablets 5 times a day for 2 weeks as an empirical treatment for less likely diagnosis of herpetic keratitis.
Her corneal oedema did not resolve three months after her first presentation. She is on the waiting list for endothelial keratoplasty after discussing the risks and benefits of the procedure in a phakic patient, in particular development of cataract.
Bilateral diffuse corneal oedema in the absence of any ocular inflammation should prompt reviewing systemic conditions and medications of the patient. Also, Amantadine, which is proved to have a toxic effect on corneal endothelial cells, should be used with caution and with regular ophthalmology visits and endothelial cell counts. Otherwise, its side effect could be drastic in this young group of patients, who are already visually and physically disable by MS.
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P118
ENUCLEATION FOR PTERYGIUM- EXCISION COMPLICATION! THE WORST SCENARIO
Pejvak Azadi
Cornea
Pejvak

azadi
Iran, Islamic Republic Of
to describe a case of Mitomycin C (MMC) - assisted- pterygium excision, ended in fungal aspergillus fumigatus endophthalmitis, which despite all efforts enucleated eventually.
eye clinic of the university hospital
Retrospective evaluation of the patient medical records.
A 55 year-old man referred for the left eye aggravating pain and decreasing vision since one week ago. He had a history of pterygium removal about 3 weeks ago. Examination revealed a displaced free conjunctival flap, scleritis with necrosis and melting, corneal ulcer and severe endophthalmitis. Emergent treatments including deep vitrectomy was done for the patient and with finding the aspergillus fumigatus as the responsible organism, appropriate treatment added too. Weeks later and due to nearly perforating corneal ulcer with impending to evisceration, and severe debilitating symptoms, the globe enucleated completely.
while pterygium excision is generally a well tolerated easily performed surgery, care must be taken especially when an adjuvant like MMC is applicated too.
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P119
MANAGEMENT OF CORNEAL CALCIFICATION AFTER CORNEAL FOREIGN BODY REMOVAL
Ismael Bakkali El Bakkali
Cornea
Ismael

Bakkali El Bakkali
Spain
To describe a case of corneal calcification after a metallic corneal foreign body, as well as the medical and surgical management.
Calcific band keratopathy (CBK) is a widely known cause of corneal calcification, in which calcium accumulates in the superficial layers of the cornea due to chronic ocular inflammation or systemic hypercalcemia. The most common methods of removing the calcium include chemical chelation with ethyl-enediaminetetraacetic acid (EDTA) and mechanical debridement.
In the case we present, calcium deposits occurred after removing a corneal foreign body.
A 45-year-old male presented with pain and redness in the left eye after being working with a radial saw the day before. Slit lamp examination showed a metallic foreign body in the central cornea. Visual acuity (VA) of the left eye was 0.9 (decimal). The foreign body was removed with a 25 Gauge needle, and the patient was treated with terramycin ointment and artificial tears.
Ten days later he came again referring visual acuity loss, presenting a VA in the left eye of light perception and a 5x6mm central corneal calcification. He was treated with topical EDTA and cycloplegic drops. Five days later, he had a mechanical debridement in the left cornea assisted with EDTA drops during the surgery.
After ten days of postoperative treatment with EDTA drops, he reached a VA in the left eye of 0.25. We removed EDTA and prescribed fluorometholone drops. Blood levels of calcium and phosphorus were normal.
Two months later, the patient reached a VA of 0.9, and presented a transparent cornea without any calcium deposits.
Corneal calcification may be a potential complication of metallic corneal foreign bodies. It is important to check out for possible calcium and phosphorus blood level abnormalities. EDTA drops may be useful for the treatment of corneal calcifications before, during and after the debridement. Using phosphate-rich drops and ocular ointments may be associated with a higher risk of corneal calcium deposits, but further studies with a larger sample are needed to confirm these findings.
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P120
DESCEMET’S MEMBRANE RUPTURE DUE TO FORCEPS INJURY: MACROSCOPIC ASPECT BY ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY
Ismael Bakkali El Bakkali
Cornea
Ismael

Bakkali El Bakkali
Spain
To describe corneal changes after birth trauma from forceps delivery, using anterior segment optical coherence tomography (AS-OCT), in order to reduce the risk of potential anisometropic amblyopia.
Descemet ruptures due to birth injury are not very usual. Here we present a case to show the importance of not having a proper diagnosis of this finding.
A 73-year-old female patient came to the ocular surface section consulting for dry eye disease symptoms. At the slit lamp examination, a vertical endothelial stria was observed in the right eye. After an exhaustive anamnesis, the patient referred having a traumatic birth in which forceps had been used.
An AS-OCT was performed, showing a vertical rupture in the Descemet membrane secondary to traumatic birth with forceps.
Descemet's membrane rupture can cause corneal oedema which usually clears over time, but those ruptures often persist. The residual corneal changes can result in anisometropia and the main cause of vision loss after such injury is anisometropic amblyopia. The AS-OCT is a useful diagnostic tool to detect these alterations at early stages.
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P121
FACTORS EFFECTING CORNEAL HAZE FORMATION FOR ACCELERATED CROSSLINKING VS CRETAN PROTOCOL: A COMPARATIVE STUDY
Ali Safa Balcı
Cornea
Ali Safa

Balcı
Turkey
To evaluate and compare the preoperative characteristics that might influence corneal haze formation after accelerated (9 mW/cm2) corneal collagen crosslinking (CXL) and Cretan protocol (combined phototherapeutic keratectomy+ corneal collagen crosslinking).
University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, TURKEY
Twenty three eyes of 20 patients who have undergone accelerated crosslinking and 23 eyes of 23 patients who have undergone Cretan protocol with stage 1-3 keratoconus according to Krumeich's classification were included in this retrospective analysis. All patients had clinically significant haze formation at minimum 6 months follow-up time. Preoperative uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), corneal topography findings, refractive features and grade of haze formation have been recorded and compared between two groups.
The mean age of the patients in CXL group was 22.3±6.7, 23.5±3.5 years in Cretan group (p:0.442). Follow up time was 11.7±4.9 months for CXL group and 7.6±1.9 months for Cretan group (p:0.001). %82.6 of eyes had grade 1 haze in CXL group and %69.6 of eyes had grade 1 haze in Cretan group. Only one eye (%4.3) had grade 3 haze in both groups and the rest of the eyes had grade 2 haze. Preoperative Kapex value was steeper, central corneal thickness was thinner and posterior elevation values (Kvb) were higher in CXL group than Cretan group (p:0.001, p:0.003 and p:0.001 respectively). Similarly Symmetry indexes of both front (SIf) and back (SIb) surfaces were higher in CXL group (p:0.043 and p:0.028 respectively)
The Cretan protocol tends to cause haze formation in eyes with earlier stage of disease than accelerated crosslinking.
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P122
KERATITIS SECONDARY TO FUSARIUM SOLANI: A CASE REPORT
Robinson Barrientos
Cornea
Robinson

Barrientos
Peru
Fusarium solani is a filamentous fungi which can produce an aggressive fungal keratitis being considered one of the most difficult ocular pathologies to manage. The main risk factor for its development is ocular trauma. Early diagnosis and adequate therapeutic management are indispensable to avoid future complications.
Department of Ophthalmology, Research Department Clínica La Luz, Lima, Perú.
A 19-year-old healthy male patient with no contributory past medical history, who works as a farmer, referring eye pain, blurred vision, burning, foreign body sensation after corneal trauma with a tree branch in the left eye (LE). Best corrected visual acuity (BCVA): Hand motion. Biomicroscopy: Conjunctival injection, dense stromal infiltrate with central feathery edges 6x6 mm and hypopyon. Treated with vancomycin, voriconazole, ceftazidime fortified eye drops, intravenous itraconazole, corneal de-epithelization and daily control.
Corneal de-epithelialization was performed in each control. After a month of follow-up, improvement of the keratitis was observed with a BCVA: 20/70. At 2 months of control BCVA: 20/50, biomicroscopy: central leukoma of 4x4mm, with mild stromal thinning, formed anterior chamber, clear crystalline lens. Phototherapeutic keratectomy (PTK) is offered in 3 months.
Perform an early diagnosis and an appropriate treatment with intravenous antibiotics and eye drops as well as serial corneal de-ephitelization are important to treat the pathology, prevent corneal perforation and avoid a penetrating keratoplasty (PK).
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P123
CORNEAL HAZE AFTER ACCELERATED CXL AND COMBINED CXL WITH TOPO-GUIDED PRK FOR PROGRESSIVE KERATOCONUS: A SCHEIMPFLUG DENSITOMETRY COMPARISON
Sara Neto Geada Batista
Cornea
Sara
Geada
Batista
Portugal
To compare corneal haze measured by corneal densitometry after corneal collagen crosslinking (CXL) alone and after combined CXL and topography-guided excimer laser ablation using photorefractive keratectomy (PRK) in the management of keratoconus.
Ophthalmology Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
University Clinic of Ophthalmology, Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
Retrospective, cross-sectional study of consecutive patients with documented progressive keratoconus that underwent either CXL (Group 1) or combined CXL and PRK (Group 2). The CXL procedure consisted of 10 min soak with 0.1% riboflavin followed by irradiation with UV-A light using 10 mW/cm² for 10 min (total dose 6 J/cm²). In the combined treatment group, patients performed a partial topo-guided PRK, before the same accelerated CXL protocol. Mitomycin C 0.02% for 20 seconds was used in these patients. Preoperative and postoperative corneal densitometry measurements were collected from the Scheimpflug-based scanning device Pentacam® (Oculus GmBH, Wetzlar, Germany), and were obtained from the anterior (120 μm), posterior (60 μm) and intermediate layers and in concentrical zones encompassing the 0 to 2, 2 to 6, and 6 to 10 central millimeters (mm). Postoperative measurements were obtained within the first year after surgery.
The study enrolled 38 eyes from 36 patients. CXL alone was applied on 18 eyes from 17 patients (47.37%), mean age 23.29±4.86 years at baseline and mean postoperative follow-up 7.17±3.43 months, while the remaining 20 eyes from 19 patients (52.63%), mean age 28.95±7.76 and mean follow-up 7.10±2.61, underwent CXL combined with PRK. A slight increase in the mean total densitometry was noted in both Group 1 (from 15.08±1.65 to 15.83±2.39, p=0.29) and Group 2 (from 16.40±1.95 to 17.09±1.94, p=0.18). A small, statistically significant, increase in densitometry was noted in the anterior 120 μm of Group 2 (p=0.03) but not in Group 1 (p=0.29). No significant differences were noted in the increase in densitometry in the medium and posterior layers in both Group 1 and 2. In the anterior (120 μm) layer, there was a significant increase in densitometry in the 0 to 2 mm zone in Group 2 (p<0.01) but not Group 1 (p=0.07). Comparing zones 2 to 6 mm and 6 to 10 mm in the anterior cornea, there were no statistically significant differences in neither Group 1 nor Group 2.
Corneal haze, measured by total corneal densitometry using a Scheimpflug imaging device, was not significantly different between both treatments. A significant increase was noted when observing the anterior cornea in patients that performed CXL combined with PRK, but not CXL alone. For CXL and PRK patients, this increase in anterior densitometry was particularly noted in the central 2 mm of the cornea.
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P124
CORNEAL MELT FOLLOWING EPITHELIUM-OFF CROSSLINKING: ABOUT A NOVEL CASE.
SAFIA BENAMAR
Cornea
Safia

Benamar
Morocco
To report a rare and vision-threatening complication of Epithelium-off ( Epi-off) Crosslinking(CXL).
Cheikh Zaid International Hospital, Eye center, Rabat, MOROCCO
A descriptive case study of a 22-year-old patient referred for tectonic corneal graft (OD) following an acute corneal melt. The patient had a history of progressive bilateral keratoconus indicating a CXL. He underwent an uneventful Epi-Off CXL on a cornea with a Minimal Pachymetry of 416 µm, and an Epithelial Thickness of 62 µm. Irradiation was performed with an intensity of 30mW/cm2, an energy of 5.4J, and a 3 min exposure time. The patient was discharged with 2 days Indometacin drops, Oral Vitamin C and analgesics. He was also prescribed Loteprednol Etabonate 0.5% and Tobramycin 0.3% , but did not use it. The patient developed a corneal melt two days following the CXL requiring an urgent management
Treatment consisted of a mid-sized 9mm Penetrating Keratoplasty for tectonic purposes. Post-operative course was simple for a follow-up time period of 8 months. Anatomopathological examination revealed the presence of a fibrinoid necrosis extending beyond the corneal stroma. Bacteriological and immunological work-up returned negative.
Management of thin corneas is a challenge for the ophthalmologist due to the potential sight-threatening complications. Crosslinking is currently evolving towards a patient-tailored treatment strategy. To this aim, the elaboration of clinical and technical check-lists for thin corneas would be helpful to prevent the onset of such complications.
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P125
MICROBIAL KERATITIS PROGRESSING TO ENDOPHTHALMITIS: CLINICAL ASPECTS, THERAPY, VISUAL PROGNOSIS AND OUTCOMES.
Souhaila Benameur
Cornea
Souhaila

benameur
Morocco
To evaluate symptoms, therapies and outcomes of microbial keratitis progressing to endophthalmitis.
Infectious endophthalmitis is a rare and severe inflammation of the intraocular tissues and fluids of the eye.
Endophthalmitis can either be exogenous or endogenous.
Although the prognosis of endophthalmitis has much improved with the advances of antibiotics and vitreoretinal surgery, of the number of patients that required evisceration or enucleation is still significant.
Retrospective study with 35 patients treated between 2019 and 2021.
The data included clinical findings, visual acuity, corneal diseases, past medical history, history of steroids and trauma, use of contact lenses, number and type of surgical interventions and causative organisms.
Our study included 35 eyes from 35 patients with endophthalmitis.
The mean age was 51.2 ± 28.9 years.
There were 13 (37.1%) women and 22 (62.8%) men.
Average time from start of ulcer symptoms to diagnosis of endophthalmitis was 8.4 ± 11.0 days
85% of the patients were on topical antibiotics before the diagnosis was made
There were pre-existent eyelid and corneal problems in 65.7%.
Ocular trauma was found in 14.2%
In 91.4 % no pathogens were identifiable.
Intravitreal injection of antibiotics was performed in all cases.
Evisceration was performed in 17.1%
Progression of infectious keratitis to endophthalmitis is relatively uncommon.
The overall outcome is poor
A prompt referral to ophthalmologists and an early intervention and closer monitoring of the disease progression in corneal ulcer are crucial for controlling ocular inflammation to prevent the loss of eyes.
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P126
EVALUATION AT 3 MONTHS OF A COMBINED INTENSE PULSED LIGHT AND PHOTO-BIOMODULATION SYSTEM IN THE TREATMENT OF MEIBOMIAN GLAND DYSFUNCTION.
Anas-Alexis Benyoussef
Cornea
Anas-Alexis

Benyoussef
France
Meibomian Gland Dysfunction (MGD) is the leading cause of dry eye syndrome. It is a frequent and under-diagnosed condition with a significant socio-economic impact. We propose here the evaluation of a platform combining pulsed light and photobiomodulation in the treatment of Meibomian gland dysfunction.
Monocentric prospective cohort conducted in the ophthalmology departement of Brest University Hospital between January 2019 and April 2020.
In this prospective study, we analysed 74 eyes of 37 patients at 1 month and 3 months after a protocol of 3 Eye-Light® (Espansione Group, Italy) sessions (15 days apart). The primary outcome was the evolution of the OSDI quality of life score. Secondary outcomes were the SPEED questionnaire score, tear breakup time (BUT), Oxford score, non-invasive break up time (NIBUT), lipid layer thickness, lacrimal meniscus height and Meibomian gland atrophy rate. Tolerance of the treatment was also evaluated.
We found a significant improvement in OSDI scores at 1 month (-17.32; 95% CI (-25.84; -8.79), p<0.0001) and 3 months (-16.95; 95% CI (-25.26; -8.64), p<0.0001). The SPEED score, BUT, Oxford score, Meibomian gland atrophy and NIBUT were also statistically improved. Tolerance to treatment was very good despite two cases of herpetic keratitis, which were resolved under treatment.
Treatment with the Eye-Light® in three sessions every two weeks significantly reduced symptoms and ocular surface damage in patients with MGD. This data suggests that the use of Eye-Light® may represent a good option for patients with MGD.
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P127
RARE FEMTOSECOND LASER INTRASTROMAL CORNEAL RING SEGMENTS
(ICRS) CHANNEL INFLAMMATION IN A PATIENT WITH KERATOCONUS
Ana Boned Murillo
Cornea
Ana

Boned Murillo
Spain
To present a rare complicarion after intrastromal corneal ring segments (ICRS) creation using femtosecond laser.
Intrastromal corneal ring segments (ICRS) in keratoconus flattens the central cornea curvature while maintaining clarity in the central optical zone and preserving corneal tissue. Channel may be created by mechanical dissection or use of a femto-second laser. Intraoperative complications (as segment decentration or superficial channel dissection with anterior Bowman layer perforation) as well as postoperative complications (for explample ring segment extrusion or infectious keratitis) have been described.
We present tha case of a 25-years-old Man who presents a rare channel ICRD inflammation 3 months after femto-second laser implantation.
Inflammation persisted after intense topical antibiotic and cycloplegia treatment, ICRD were explanted and channel sample were obtained to perform cultures, which were negative.
Intrastromal corneal ring segments channel inflamation must be taken in consideration as a rare postoperative complication after femtosecond laser surgery.
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P128
HERPETIC KERATO-UVEITIC: WHEN INFLAMMATION, EDEMA AND DRYNESS GET COMBINED!
Lina Boualila
Cornea
Lina

BOUALILA
Morocco
Showing a presentation of unilateral kerato-uveitis associating typical signs of herpetic lesions.
Ophthalmology A department, Ibn Sina hospital, Rabat, Morocco
A 45 year old woman, with no pathological history, consulted for an acute pain, redness and decreased vision of the left eye.
The ophthalmologic examination found: Visual acuity 20/20 at the right eye, hand motion at the left eye.Intraocular pressure: 20mmHg right eye, 35mmHg left eye. In the left eye, we found blepharitis, peri keratic circle, conjunctival hyperemia, BUT<10s, corneal hypoesthesia, superficial punctate keratitis, corneal edema with epithelial and subepithelial bubbles of different sizes, mixte diffuse retro-corneal precipitates, crystalline iris synechiae on 360 degree, cellular and proteic tyndall of the anterior chamber 3+, the rest of the examination was impossible. No particularity was found in the right eye. A treatment based on valacyclovir 3g per os, dexamethasone eye drops, acetazolamide per os, local atropine, preservative-free artificial tears, sodium chloride 5% eye drops and vitamin A ointment.
One month later, the evolution was marked by the gradual decrease of intraocular inflammation and corneal edema and persistence of hypertonia. The progressive degression of valacyclovir and corticosteroid and an intensification of the dryness treatment led to a disparition of the inflammation with persistence of corneal edema sequelae.
Physiopathology of inflammation, edema and dryness are intertwined. Therefore, the treatment has to cover the three to break the vicious circle.
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P129
CASE REPORT :MULTIRESISTANT CORNEAL ABSCESS ON TRANSFIXING KERATOPLASTY
Neama Bouhazzama
Cornea
Neama

Bouhazzama
Morocco
Corneal abscess is serious complication after corneal transplantation threatening the viability of the grafted tissues and visual outcomes of patients.
ophthalmology department; August 20th,1953 hospital Ibn Rochd University Hospital Center Faculty of Medicine and Pharmacy Casablanca Hassan II University (Morocco)
We report a case of multiresistant infection following penetrating keratoplasty 5 months postoperatively.
A 18-year-old man with keratoconus underwent a penetrating keratoplasty. 5 months after surgery, the patient experienced a sudden decrease in vision and severe eye pain and developed a corneal abscess in the graft-host interface measuring 3mm/3mm without an intraocular infection. A corneal swabs were taken. Fortified eye drops based on ceftazidime and vancomycin was ineffective on halting the progression of the infection. A multiresistant streptococcus viridans was isolated.
After a penetrating keratoplasty, infection may develop at the graft-host interface. the setting of an adapted treatment can reduce the risk of development of endophthalmitis and the loss of th graft.
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P130
TREATMENT OF CORNEAL PERFORATION SECONDARY TO UNDIAGNOSED SJOGREN’S SYNDROME WITH CONJONCTIVAL FLAP : A CASE REPORT
Sophia Bousseta
Cornea
Sophia

Bousseta
Morocco
Dry eye is a common problem affecting mainly the adult population and especially in sjogren's syndrome .In severe cases, it can result in sterile corneal ulcer and perforation.
The treatment of non-traumatic perforations of the cornea is a real challenge for the choice of surgical technique as well as for management of the causal pathology
The clinical evolution is commented and the available therapeutic measures for this complication are discussed
A case of noninfectious corneal perforation in a 43 year old patient with Sjögren's syndrome is reported
A 43 year-old femal presented to the outpatient department with complaints of painful decrease in vision in both the eyes for the past seven days. The decrease in vision was associated with photophobia and redness, more in left eye than right. There was no history of any trauma to any eye.
Examination disclosed vision of counting fingers at 50 cm on the left eye , and 2/10 ème on the right eye
Slit lamp examination revealed lusterless congested conjunctiva in both the eyes.
There was a sterile corneal ulcer of size 1.5x1.5 mm in right eye
And sterile corneal ulcer of size 5.5x4.0 mm in left eye with central corneal perforation measuring 2mm / 1.5mm with iris plugging the perforation
The anterior chamber was flat in left eye
the patient received a corticosteroid bolus and partial conjunctival flap on the left eye
He was started on topical antibiotic and preservative free artificial tears at two hourly interval and oral acetazolamid
On the next dayAnterior chamber was of normal depth when examined next day
Autoimmune screen disclosed a diagnosis of Sjögren's syndrome, and the patient was commenced on systemic immunosuppression
1 month later, visual acuity was 3/10 left eye , and 8/10 right eye
with an anterior chamber reformed at left eye and regression of the ulcer at the right eye

Sjögren's syndrome is an autoimmune disorder characterised by a variable degree of sicca symptoms including keratoconjunctivitis sicca and xerostomia
In the eye, it is considered predominately as an aqueous tear deficiency with an additional insufficient lipid layer component.
The purpose of a conjunctival flap is to restore the integrity of a chronically compromised corneal surface,63,64 and provide metabolic and mechanical support for corneal healing
A conjunctival flap will often provide comfort, reduce the ocular inflammation, and promote healing in these patients.
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P131
COMPARISON OF CHOROIDAL AND MACULAR SUBFOVEAL THICKNESS IN HEALTHY AND KERATOCONUS EYES OF DIFFERENT STAGES.
Neus Burguera-Giménez
Cornea
Neus

BURGUERA GIMÉNEZ
Spain
To compare subfoveal choroidal thickness (SCT) and subfoveal macular thickness (SMT) measurements of healthy and keratoconic eyes depending on keratoconus (KC) severity.
FISABIO Ophtalmological Medical Centre (FOM), University of Valencia, Catedra Alcon-FISABIO-UVEG
Cross-sectional and prospective case-control study with 80 eyes of 60 KC and 20 control patients aged between 18 and 50 years recruited from FISABIO Ophthalmological Medical centre. All patients underwent a comprehensive ophthalmological exam including subjective refractive error, slit lamp biomicroscopy, axial length (AL) measurement with IOL Master 700 (Carl Zeiss Meditec, Jena, Germany) and corneal analysis with Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany). SMT and SCT were automatically obtained from Swept Source OCT (DRI-1 Atlantis SS-OCT, Topcon Medical System, Japan) using the 12 mm line scan pattern. Only eyes with AL between 22 and 26 mm and spherical equivalent (SE) less than -6.00 D were included. KC eyes were stratified in 4 groups considering the topographic KC classification (TKC): TKC0 (TKC= possible and fellow eye with diagnosed KC, n= 18), TKC1 (n=17), TKC2 (n=17) and TKC3 (n=8). Shapiro-Wilk test showed that SMT was not normally distributed, hence, Mann-Whitney test was used to compare the two main groups whereas Kruskal-Wallis test was run to explore SMT variations between all subgroups. SCT was normally distributed, thus, T-test was used to compare KC and healthy while one-way analysis of variance (ANOVA) with Tukey post hoc was used for assessing SCT differences between control and KC subgroups.
Mean age (28.70±7.50 vs. 30.67±9.90 years, U=551.5, p=0.59), mean SE (-2.15±1.90 vs. -1.80±1.70 D, U=492.5, p=0.23) and mean AL (24.23±0.99 vs. 24.03±1.08 mm, U=661.5, p=0.49) did not show statistical differences between healthy and KC eyes. Similar SMT were observed in both groups (control 240±20 vs. KC 246±25 μm, U=543, p=0.59), whereas KC presented significant thicker SCT compared to non-KC eyes (KC 311±60 vs. control 263±88 μm, t(25.17)=2.24, p=0.034). As KC phases increased, SMT became thinner: TKC0= 254±23 μm; TKC1= 240±13 μm; TKC2= 250±33 μm; TKC3= 235±25μm; Nevertheless, multiple comparisons manifested not statistical differences among all groups (H(4), p=0.34). The choroid suffered a slight thickening in early KC stages (TKC0= 300±65 μm; TKC1= 320±73 μm). However, SCT remains unchanged in advanced KC grades (TKC2= 310±54 μm; TKC3= 316±33 μm). One-way analysis of variance revealed non statically significant SCT variations between healthy and KC subgroups (F(5,75)=1.96, p=0.11).
Choroidal thickness seems to be increased in early KC stages remaining stable in advanced phases. Macular thickness decreased as the KC phase increased. Although a choroidal thickening could be expected in KC eyes, further investigations are needed to confirm the role of the choroids in the KC activity due to the non-statistical differences among healthy and KC subgroups.
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P132
TEAR FILM, OCULAR SURFACE AND CORNEAL EPITHELIAL ALTERATIONS MEASURED BY ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY IN CHRONIC SMOKERS
Ana Rita Carreira
Cornea
Ana Rita

Carreira
Portugal
Our aim was to assess the effect of smoking habits on ocular surface, tear film stability and corneal epithelial thickness (CET).
Hospital Garcia de Orta E.P.E, Almada, Portugal
This study included healthy age-matched non-smokers and current cigarette smokers. Signs (Schirmer test I, Tear Film Break-up Time Test (TBUT), corneal fluorescein staining (CFS) score) and symptoms (Ocular Surface Disease Index (OSDI) questionnaire) of dry eye disease (DED) were evaluated, in accordance with the International Dry Eye WorkshopII criteria of DED. CET map was also assessed (Cirrus HD-5000Ò;).
Twenty eyes were included in the Non-smokers group, with a mean age of 40.03±6.78 years, and 21 in the Smokers group, with a mean age of 42.24±3.51 (p=0.08). Smokers group had higher OSDI (10.60±2.12 vs 14.27±2.60, p=0.04) and CFS score (3.01±0.42 vs 7.00±1.03, p=0.001) and lower TBUT values (12.23±1.34 vs 5.42±1.76s, p<0.001). Proportion of DED diagnosis (10 vs 100%, p<0.001) was higher in smokers. Superior CET measurements were lower in Smokers group (p<0.05). Smoking index was correlated with TBUT and superior and temporal CET measurements (p<0.05).
Smoking has a negative impact on ocular surface and corneal epithelial thickness, with a higher level of eye dryness and corneal thinning. These findings tend to be globally more severe in patients with greater cumulative exposure.
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P133
PREPERFORATIVE NEUROTROPHIC ULCER: NEW MANAGEMENT APPROACH
Zakaria Cheikh
Cornea
Zakaria

cheikh
Morocco
Neurotrophic keratitis is a chronic degenerative disease of the corneal epithelium secondary to a reduction or absence of corneal sensitivity. The most common etiology is the herpes simplex virus. It poses a double problem, firstly diagnostic; because the corneal sensitivity examination is often omitted, and secondly therapeutic, because to the absence of a standardized consensus and the difficulty of management. The aim of this case is to evaluate the effectiveness of autologous serum associated with scleral lens.
We report a case of a 32-year-old man, followed for neurotrophic keratopathy of herpetic origin at the stage of preperforative ulcer, since 20 days, resistant to treatment by intensive lubrication. The restoration of corneal integrity was an absolute emergency. On examination, the right eye showed visual acuity at 3 meters, the anterior segment showed a nasal para-central ulcer with raised edges, oval shape, the lower half of the cornea surrounded by edema and absent corneal sensitivity, a good anterior chamber, a clear lens with an unremarkable fundus. The left eye had an uncorrected visual acuity of 10/10 and an unremarkable examination.
The initial management was the placement of synthetic glue at the bottom of the ulcer, 2 days later we had a rejection of the glue; and then we opted for adapted scleral lenses for therapeutic purposes with placement of autologous serum as a filling solution for the scleral lens. After 3 months, the evolution was marked by re-epithelization with partial recovery of corneal sensitivity.
In all chronic corneal ulcers, corneal sensitivity should be tested. Current medical or surgical treatments for neurotrophic ulcers are aimed at improving epithelial healing, slowing down the evolution and preventing possible complications. The use of scleral, high Dk, non-windowed, autologous serum-filled lenses in daily use allows the restoration of corneal integrity and sensitivity.
The diagnosis and management of neurotrophic keratitis is a real challenge. The use of the scleral lens as a reservoir for the active ingredient (autologous serum in our case) can give a new impetus to the management of this corneal pathology.
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P134
PERIPHERAL ULCERATIVE KERATITIS (PUK) REVEALING OCULAR SYPHILIS : A CASE REPORT
Selma Chiguer
Cornea
Selma

Chiguer
Morocco
Peripheral ulcerative keratitis (PUK) is a form of peripheral crescent-shaped corneal ulcer involving the area adjacent to the limbus and characterized by sectoral thinning of the cornea. It is usually caused by both autoimmune and infectious diseases. PUK due to infectious diseases is rare, with syphilis as a cause of PUK rarely reported in the literature. Here, we describe a rare case of unilateral PUK revealing a syphilis infection.

Ophtalmology department, University Hospital Ibn Rochd, Faculty of medecine and pharmacy, Casablanca.
We report the case of a 30-year-old man, with unsafe sexual relation, who consults for pain and redness in left eye for 1 month, associated with a pustular rash on the face that appeared a few days before, without other extra ocular manifestation.
General examination only found a pustular rash on the face, on ophthalmologic examination, his visuel acuity was 10/10in the both eyes. The right eye was normal, in the left eye we found a conjunctival hyperhemia, two inferior peripheral ulcerative keratitis (PUK) in temporal and nasal, with thinning and stromal infiltration, corneal sensation was normal, we also found an anterior uveitis with low tyndall, without posterior synechiae, the intraocular pressure was 12mmHg, the rest of examination was normal. Cultures from the peripheral ulcer were negative for any infectious organism, and then we started a treatment with topical prednisolone without improvement. More investigations were done including inflammatory biological disorder, serum rheumatoid factor, antinuclear antibody, serum angiotensin converting enzyme levels which were normal. Tests for other infective agents were also performed, such as hepatitis B and C and human immunodeficiency virus, which were found negative and only the treponemal antibody test was positive. The patient was then treated on 2.4 million units of benzathine penicillin G intramuscularly once weekly for 3 consecutive weeks in addition to topical steroids for PUK treatment. The response to the treatment was good, with the ulcer started to heal, and a complete resolved anterior uveitis.
Syphilis, known as 'The Great Imitator', has varied clinical manifestations not only systemically, but also, in this case, in its ocular manifestations. Here, it presented as unilateral PUK, which is rarely reported. This case also showed the importance of initiating systemic antibiotics in treating infective causes of PUK. Our results indicate that syphilis should be kept in mind as a differential diagnosis in non healing cases of PUK.
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P135
EVALUATION OF SCLERAL THICKNESS IN KERATOCONUS PATIENTS
Mukaddes Damla Ciftci
Cornea
Mukaddes Damla

Ciftci
Turkey
Keratoconus is a noninflammatory, progressive disease that causes corneal thinning and irregular astigmatism. Its etiology has not been fully elucidated. Family history is present in 6-8% of patients. Although it is usually an isolated pathology, it can sometimes be seen together with systemic disorders such as Down syndrome and atopy. Connective tissue diseases such as mitral valve prolapse, Marfan syndrome, Ehlers-Danlos syndrome can also accompany keratoconus. This suggests the role of collagen tissue in the pathogenesis of the disease. Optic coherence tomography (OCT) is a non-invasive imaging method that allows two-dimensional, high-resolution imaging of ocular tissues. Anterior segment optic coherence tomography (AS-OCT) allows visualization of corneal layers, anterior chamber, iris and iridocorneal angle details.The aim of this study is to evaluate the scleral thickness of keratoconus patients with AS-OCT.
The study was conducted with consecutive keratoconus patients who came to Ege University Department of Ophthalmology for their routine controls from March to May 2021. Control group consisted of 36 healthy volunteers.
The right eyes of 36 patients diagnosed with keratoconus (Group 1) and the right eyes of 36 healthy volunteers (Group 2), who were matched in terms of age, gender and axial length, were included in the study. Following a detailed ophthalmological examination in both groups, as the method described by Imanaga et al. scleral thickness measurements were taken with AS-OCT 6 mm behind the scleral spur in 4 viewing positions as superior, temporal, nasal and inferior. Statistical analyses were performed using the SPSS software version 28.0 and the Mann-Whitney U test.

There was no significant difference between the two groups in terms of age, gender and axial length. Inferior quadrant scleral thickness measurements were statistically significantly thinner in Group 1 compared to Group 2 (417.44±24.48 vs 436.69±23.04 µm; p<0.01). There was no statistically significant difference between the 2 groups in the superior (407.30±31.79 vs 417.38±27.36 µm; p=0.1), temporal (407,16±36.23 vs 414.50±262.8 µm; p=0.17) and nasal (421.94±25.27 vs 430.77±26.86 µm; p=0.06) quadrants.
Although the pathogenesis of keratoconus is not known exactly, it is known that the bonds between collagen fibers are destroyed. Considering that the basic building block of the cornea and sclera is collagen, it seems possible that the sclera is also affected by this progressive process. A larger number of cases should be evaluated in future studies.

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P136
CORNEAL ULCERATION AS POTENTIAL COMPLICATION OF INTRASTROMAL BEVACIZUMAB INJECTION FOR CORNEAL NEOVASCULARIZATION IN LIPID KERATOPATHY
Pablo Andres Cisneros Arias
Cornea
Pablo
Andres
Cisneros Arias
Spain
The purpose of this study was to report a potential complication after corneal intrastromal bevacizumab injection on corneal neovascularization in patients with lipid keratopathy secondary to long-term neurotrophic keratitis. The ulcers were fully healed and with stable epithelium prior the injection.
Bevacizumab, a full-length humanized monoclonal antibody against vascular endothelial growth factor (VEGF), has been used as treatment in lipid keratopathy with good outcomes and an adequate safety profile. To our knowledge, the only complication reported has been an uncomplicated minor intracorneal hemorrhage.
Two eyes of two patients with lipid keratopathy due to a long-term neurotrophic keratitis accompanied by corneal neovascularization received 1 dose of corneal intrastromal bevacizumab. 10 days follow-up examination not only revealed some degree of regression of corneal neovascularization and reduction in lipid deposition but also showed a corneal desepitheliazation in both patients.
It was proposed to add insulin eyedrop to the topical treatment with artificial tears, antibiotics and autologous serum drops. Three weeks later, it was found a clear regression of the ulcers. The visual acuity improved and the corneas of both patients showed less opacity accompanied by neovascularization and lipid density reduction. No other problem of toxicity has been detected. Treatment will be maintained chronically and its gradual withdrawal will be evaluated. New bevacizumab injections are still considered in the future.
Intrastromal bevacizumab treatment is generally safe and well-tolerated and provides good outcomes. But in patients with severe neurotrophic keratopathy or epithelial defects, care must be taken. A close and vigorous follow-up is always necessary in these patients.
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P137
RECURRENT CORNEAL MELTING IN A PATIENT WITH STAGE IV LUNG ADENOCARCINOMA: A CASE REPORT
Nuria Cuenca Cardeñosa
Cornea
Nuria

Cuenca Cardeñosa
Spain
To show the management of a patient with stage IV lung adenocarcinoma under chemotherapy treatment with Bevacizumab, Carboplatin and Paclitaxel, who presents recurrent and spontaneous corneal melting.
69-year-old male patient diagnosed in 2019 with stage IV lung adenocarcinoma under current treatment with Bevazicumab, Carboplatin and Paclitaxel. He went to the emergency room due to a red left eye with pain, with a diagnosis of spontaneous central corneal perforation. It was decided to place Hystoacril and contact lens. In subsequent check-ups, a thinned corneal ulcer was observed in the right eye with a thickness greater than 50%, so it was decided to place Hystoacril and contact lens also. Surgery was scheduled to place amniotic membrane in both eyes, but due to a low platelet count, the intervention could not be performed. A new thinned ulcer was discovered in the right eye not previously described, so Hystoacril was placed again on the ulcer, in the operating room. The patient is currently with Hystoacril and contact lens in both eyes, undergoing topical antibiotic treatment, artificial tears, and oral doxycycline, waiting to finish chemotherapy and an analysis to reevaluate platelets.
69-year-old patient with stage IV lung adenocarcinoma undergoing chemotherapeutic treatment at Toledo Hospital Complex (Spain), with recurrent and spontaneous corneal melting.
Spontaneous ocular perforation and recurrent corneal melting in a patient undergoing chemotherapeutic treatment with Bevazicumab, Carboplatin and Paclitaxel, treated with Hystoacril and contact lens. When he has an adequate analysis, an amniotic membrane will be placed in both eyes in the operating room.
Corneal melting in this patient may be due to the toxicity of chemotherapy treatment. In the literature, ocular surface toxicity in cancer patients is more related to EGFR inhibitors and Pembrolizumab. Therefore, we must pay attention to the ocular surface of cancer patients regardless of the chemotherapy treatment they are with.
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P138
INFLUENCE OF CATARACT SURGERY ON MEIBOMIAN GLANDS, TEAR FILM & OCULAR SURFACE IN DIABETIC AND NON DIABETIC POPULATION: A COMPARATIVE TRIAL
Lional Raj Daniel Raj Ponniah
Cornea
Lional Raj

DANIEL RAJ PONNIAH
India
To evaluate and compare the morphological changes of meibomian glands and the functional changes of the tear film and its impact in diabetic and non-diabetic subjects who underwent uneventful phacoemulsification procedures
A Prospective comparative clinical trial conducted in the department of Cornea & Ocular surface diseases, at a tertiary eye care hospital and teaching institution
A Prospective investigator-masked comparative clinical trial. Cataracts with and without Diabetes were recruited based on age & grouped as Group 1 (No OM and age<60 yrs; N=43) Group 2 (OM and age<60 yrs; N=39) Group 3 (No OM and age> 60 yrs; N=51), Group 4 (OM and age>60 yrs; N=67). Preoperative meibography and functional tear film using quantitative measurements of tear meniscus studies, non invasive tear break-up time (NIBUT), blink rate were analysed & compared with 21 days and 3 months post-surgery. Ocular Protection Index (OPI) was calculated as a function of ocular surface health by dividing tear break up time by interblink interval. OPI<1 is susceptible to surface damages
Baseline NIBUT was 11.80, 9.50, 10.30 & 7.88 respectively across Gr 1 through 4, which reduced to 8.34, 7.31, 7.36 and 6.11 21days post surgery, restored to baseline at 3 months. Mean OPI was 1.37 at baseline, 0.97 at 21days, 1.10 at 3 months. ANOVA for OPI had significant time effect, Wilk's Lambda = 0.813, p<0.0001. Preop OPI was 1.88, 1.26, 1.67 and 0.88 respectively across Gr 1 through 4, which reduced to 1.68, 0.91, 1.03 and 0.75 at 21days, restored to baseline at 3 months. Gr4 had poor OPI score of less than 1 at all time points No significant difference in tear meniscus height across the groups. Age adjusted OM influence on Meibomian gland loss was 12.1% compared with non-OM, 6.64%
Subjects over 60 years of age irrespective of concomitant OM had borderline OPI, are susceptible to develop surface damages post cataract. Subjects with OM irrespective of age had borderline OPI, likely to suffer surface damages post cataract. Subjects who are over 60 years with OM had suboptimal OPI & require a long-term ocular surface protectors
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P139
ARE SAME DAY AND DAY ONE POSTOPERATIVE REVIEWS CLINICALLY NECESSARY AFTER DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK) PERFORMED WITH AN INFERIOR PERIPHERAL IRIDOTOMY (PI)?
Max Davidson
Cornea
Max

Davidson
United Kingdom
To determine the incidence of day 1 postoperative complications after DMEK performed with intraoperative inferior PI, and whether their early detection influences post-operative intervention.
Currently it is standard practice to review post-DMEK patients on the same day as surgery and/or the following day, to detect early complications such as high intraocular pressure due to pupil block, inadequate bubble size or graft detachment.

Patients that underwent either DMEK alone or combined with phacoemulsification and posterior chamber intraocular lens insertion (triple DMEK) between August 2019 and August 2021 were identified. Patients not receiving PI were excluded. Laterality, grade of surgeon and any action taken at day one and week one review were noted.

72 DMEKs with inferior PI were performed, of which 43 (59.7%) were triple DMEK. 20 cases (27.7%) were performed by a consultant ophthalmologist, with the remainder performed by a fellow. No pupil block or other major adverse events were found at day one review. At one week, 14 (19.4%) required re-bubbling, 2 (2.8%) required repositioning, 1 (1.4%) required re-graft and 1 (1.4%) underwent YAG laser to vitreous strands prolapsed through the PI.
This series suggests that inferior PI performed alongside DMEK alone or triple DMEK effectively minimizes the risk of pupil block. Since no early complications occurred in this cohort requiring immediate intervention, it may be safe to defer review of these patients to a later time point. This may improve graft success rates in an outpatient setting by maximising uninterrupted posturing time and may be more practical in public-funded healthcare settings.
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P140
EARLY ENDOTHELIALIZATION OF AB INTERNO LAMELLAR STROMAL TECTONIC PATCH IN THE MANAGEMENT OF CORNEAL PERFORATION SECONDARY TO BACTERIAL KERATITIS.
Max Davidson
Cornea
Max

Davidson
United Kingdom
To describe a novel surgical technique using an ab interno lamellar stromal patch to treat corneal perforation, and to present the histological findings of the patch following its removal during subsequent mushroom keratoplasty.
Various technical permutations of Descemet stripping (automated) endothelial keratoplasty (DS(A)EK) have recently been proposed in sealing corneal perforations from within the anterior chamber. This approach avoids potential suture-related complications induced via the conventional anterior or full thickness approach. In tectonic DSAEK, the pressure gradient across a large corneal perforation may be more important in promoting graft adherence than the pump function of donor endothelium. We recently had the opportunity to test this hypothesis via a case in which stromal material without endothelium was used as an ab interno patch to seal a corneal perforation.

A 22-year-old female presented with a large paracentral corneal perforation affecting the visual axis, secondary to a large pseudomonas corneal abscess.
The patient was managed successfully with a sutureless ab interno stromal tectonic patch, prepared from tissue that had already been used to harvest an endothelial graft on the same day. 2 months later, definitive mushroom keratoplasty was performed and the patch was sent for histological examination. Immunohistochemistry revealed a reactive endothelium covering the posterior surface of the graft. Nine months later her best corrected visual acuity was 6/9.

This is the first case to our knowledge demonstrating that stromal tectonic grafts without endothelium can successfully attach to host tissue and seal a perforation. The use of leftover graft material for this indication may reduce pressure on tissue bank supply. Stroma may undergo re-endotheliazation and begin to restore vision, even prior to PK.
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P141
OCULAR ROSACEA; DIAGNOSTIC PROFILS AND THERAPEUTIC DIFFICULTIES
Hamidallah Doha
Cornea
Hamidallah

Doha
Morocco
The purpose of our work is to determine the incidence of ocular involvement in a population monitored for ocular rosacea in the ophthalmology service at the university hospital of CASABLANCA, while aknowlging the diagnostic elements and the therapeutic difficulties..

Ocular rosacea is a complication of a common condition called cutaneous rosacea. The physiopathology of this eyelid complication is not clearly known and goes down to a dysfunction of the secretion of the meibomian glands.
During the period from January 2020 to September 2021
we examined the eyes of 60 patients with rosacea with all degrees of severity who had a follow up at the ophthalmology department of the IBN ROCHD CASABLANCA University Hospital Center morocco.

During this period 60 patients consulted the dermatology department for cutaneous rosacea;
About 14 patients (20%) presented ocular rosacea.
The average age of patients with rosacea was 43 years (16 to 70 years), with a clear predominance of women
10 patients with ophthalmologic manifestations presented with mild to moderate erythematotelangiectatic rosacea.
Ocular involvement was bilateral in 90% of patients

The main ophthalmologic manifestations were dominated by chronic blepharitis (100% of patients), superficial punctate keratitis with altered BUT in 70.% of patients, 8 patients presented with chalazion, 2 patients had entropion, and 1 patient only presented phlyctenular conjunctivitis, corneal ulcer in 2 patients and corneal abscess in 1 patienT
Medical treatment in all of our patients consisted in eyelid hygiene measures combined with topical azthromycin.
Systemic cyclins have been used apart from their contraindications.
The children were treated with macrolides.
26 patients started Local corticosteroid

Patients with entropion have undergone a surgical cure after the inflammatory outbreak had subsided

the patient with a corneal abscess required hospitalization with local and general antibiotic therapy based on fortified eye drops.

A clinical improvement were noticed in the majority of patients with stabilization of the lesions.
ocular rosacea is quite common.
It is often unrecognized, sometimes progressing insidiously to serious complications.
Collaboration between ophthalmologists and dermatologists is necessary for better management of the disease.
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P142
UNILATERAL INTERSTITIAL KERATITIS AS PRESENTING SIGN OF OCULAR TUBERCULOSIS :CASE REPORT
Hala El Belidi
Cornea
Hala

EL BELIDI
Morocco
Tuberculosis (TB) is a disease that primarily affects the lungs, but may also affect extrapulmonary organs, including the eye.
Mycobacterium tuberculosis may affect any structure of the eye masquerading as several infective as well as non infective entities and the clinical course generally tends to be insidious and chronic.
Ocular surface involvement in ocular tuberculosis (OTB) is uncommon as compared to TB . Corneal involvement in OTB can occur in the form of phylectenulosis, interstitial keratitis (IK), or disciform keratitis .
HOPITAL DES SPECIALITES . RABAT. MOROCCO
We report a 24-year-old female patient presented with the complaint of decreased vision in her left eye since 1 month . There were no systemic complaints, and family history was insignificant.
On examination, best corrected visual acuity in her left and right eye was 20/63 and 20/20 respectively.
Slit-lamp examination of the left eye showed hyperemia ,peripheral corneal opacities with deep corneal vascularization around the areas of stromal infiltrates and ghost vessels , posterior synechiae , iris nodules; anterior chamber reaction cells 2+, Flare 1+ . Corneal sensation and intraocular pressure was normal. Vitreous was clear, and indirect ophthalmoscopy of fundus was normal .
Slit-lamp and fundus examination of the right eye was unremarkable.
Laboratory investigations revealed raised erythrocyte sedimentation rate (54 mm/hr) and positive tuberculin test and interferon gamma release assay .
Patient was referred to internist to rule out any active or latent systemic focus of infection, but none was found. Contrast enhanced computed tomography of chest, abdomen, and brain was normal.

The patient was started on antitubercular therapy and topical steroids . After this, visual acuity improved to 20/32 .
Anterior chamber cell grade reduced to 0.5+ cells with residual corneal scarring.
Patient was followed up for a period of one year after completion of antitubercular therapy with no recurrence of ocular disease.
IK refers to the nonsuppurative and nonulcerative inflammation of the cornea presenting as edema, infiltration, and vascularization of stroma in acute phase. Resolution of the inflammation leads to
scarring and thinning of stroma along with ghost vessels. The most common cause of unilateral IK is herpes simplex virus and that of bilateral IK is idiopathic followed by syphilis. OTB causing IK is uncommon .
The diagnosis of ocular TB usually relies upon the indirect evidence along with the exclusion of other differential diagnoses. Our case showed the ocular feature of anterior granulomatous uveitis, and positive tuberculin test and interferon gamma release assay , and raised raised erythrocyte sedimentation rate suggestive of TB.
OTB can have varied manifestations, and an unusual presentation may delay diagnosis and increase ocular morbidity. Therefore, Mycobacterium tuberculosis must be kept in mind when countering atypical manifestations especially in endemic countries.
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P143
CYANOACRYLATE GLUE USE FOR TRAUMATIC CORNEAL PERFORATIONS
Rim El Hachimi
Cornea
Rim

El Hachimi
Morocco
The purpose of our 3 cases is to describe the surgical management with cyanoacrylate glue and highlight the difficulties and outcomes.
Mohammed V University, University Hospital Ibn Sina Rabat, Departement A of Ophthalmology, Morocco
We report 3 cases of traumatic corneal perforation of diameter less than 2 mm with foreign body in which we proceeded to the ablation of the foreign body under general anesthesia followed by closing of the perforation by a cyanoacrylate glue. A paracentesis was performed to fill the anterior chamber with ophthalmic viscoelastic device (OVD). The next step was epithelial scarification was performed on an area 2 mm including the perforation. Then we proceeded to the preparation of the glue pad by droping the round back of the micro-sponge rod with glue and removing the excess by tapping it gently on a smooth surface. The glue was applied on the 2mm circle like a stamp. After that, we did an hydrosuture or paracentesis closure with a 10.0 monofilament tip after cleaning intracameral OVD. Finally, we injected intracameral antibio-prophylaxis before placement of a soft lens bandage
The major complication of the use of cyanoacrylate glue is the toxicity to the corneal endothelium and the lens when it is in direct contact with these structures. Our surgical technique aims to avoid excess of cyanoacrylate glue deposit on the clear cornea and to prevent the glue from passing into the anterior chamber (toxicity). In the immediate postoperative period, we obtained excellent sealing of the anterior chamber with closure of the perforation. Scarification allows better adhesion of the glue to the corneal surface and increases the success. the application of a thin layer of the adhesive which exceeds the surface of the perforation prevents penetration into the anterior chamber. In the first case, the applied glue was spontaneously detached after ten days. The second patient underwent transfixing keratoplasty with excellent results. The last patient was scheduled for transfixing keratoplasty. All cases were managed in the post-operative period by antibiotics and anti-inflammatory drugs with regular change of the bandage lens. We noted any infectious complication in all cases. In one case the full thickness defect was tunnel shaped. Thus, OCT based monitoring of the healing process was limited by the mask effect of the glue.
Corneal patching with cyanoacrylate glue is a temporizing procedure only, buying time to allow healing secondary to medical treatment of the underlying condition, or allowing surgery to be elective and under more optimal conditions once inflammation has been reduced and the integrity of the globe restored. Further procedures are not always required, although when needed, the restored integrity of the globe following application of cyanoacrylate glue makes these procedures more successful.
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P144
SCHNYDER'S CRYSTALLINE CORNEAL DYSTROPHY: A CASE REPORT.
Mohcine El Mhadi
Cornea
Mohcine

El mhadi
Morocco
Schnyder's crystalline dystrophy is a rare hereditary corneal disease, the clinical forms can be varied.
It is classically characterized by the presence of central corneal opacities, disc or ring, with or without crystals, and sometimes associated with a peripheral corneal arch or the limbic belt of Vogt.
The pathogenesis is linked to an abnormality of lipid metabolism with accumulation of lipids at the corneal level.
The purpose of our observation is to recall the clinical and biological characteristics of Schnyder's corneal dystrophy, and to underline the risk of the occurrence of diffuse vascular damage favoring cardiovascular accidents.
We report the case of a 30-year-old patient that was referred to us for a gradual decline in visual acuity.
The patient has reported the appearance of white spots in her eyes, gradually increasing in size over the past 15 years.
The corrected visual acuity was 3/10 in the right and 2/10 in the left eye, and the intraocular pressure was 14 mmHg in the right and 16 mmHg in the left eye.
Biomicroscopic examination revealed bilateral and symmetrical involvement with central corneal opacities, in disc form following an accumulation of iridescent crystals in the central portion of the stroma, a peripheral lipid arc with a haze in the middle periphery.
The patient had an anterior segment optical coherence tomography (OCT): areas of hyper-reflectivity corresponding to the location of the lesions were visible in the stroma, reaching its full depth.
Schnyder's crystalline dystrophy is a rare hereditary corneal disease, the clinical forms can be varied.
It is transmitted in an autosomal dominant manner, the responsible gene being located on the short arm of chromosome 1.
The signs found in this dystrophy result from the accumulation of cholesterol and phospholipids in the corneal stroma associated with a degeneration of collagen fibrils.
Schnyder's crystalline dystrophy is typically characterized by the presence of fine crystals forming a central round or oval, annular or disc opacity in the anterior stroma, and it is now well established that crystals are present in about 50% of cases, as is the case in our patient.
In patients with this pathology, hypercholesterolemia should be sought in order to be treated if necessary. Other classic associations should also be sought, such as: genu valgum, chondrodystrophy or atherosclerosis with diffuse vascular suffering.
No treatment is available to stop the progression of this disease. However, several surgical techniques can be proposed, the choice of which depends on the depth of the damage to the stroma.
The clinical case reported here, very suggestive of Schnyder's dystrophy, underlines the value of clinical examination for diagnosis.
Ophthalmologists should be aware of the ocular and general signs of this disease in order to preserve the functional visual and cardiovascular prognosis.
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P145
BILATERAL INFECTIOUS KERATITIS REVEALING A PRIMARY IMMUNEDEFICIENCY : CASE REPORT
Salma El Moataz Billah
Cornea
Salma

EL MOATAZ BILLAH
Morocco
Neutropenia in the context of primary immunodeficiency is a condition that is not seldom encountered in the pediatric population. An unusual severe course- or unusual frequency of infection is often the consequence. A predisposition for auto-immune- and auto-inflammatory phenomena and a tendency to develop malignancies are also identified. Cases of corneal disease in patients with primary immunodeficiency are limited in the literature.
Ophtalmology departement of 20 Aout 1953 University Hospital of Casablanca, Morocco.
We describe a case of bilateral infectious keratitis associated with methicillin-resistant Staphylococcus aureus in a patient with a severe congenital neutropenia . There were no common risk factors for bacterial keratitis, such as prior history of ocular surface disease, trichiasis, trauma, or contact lens wear.

The patient was a male born to first cousin parents. He was admitted due to neonatal sepsis on the fourth day after birth. The patient was re-hospitalized at 2 months of age because of pneumonia. At 4 months of age, the patient presented to the ophtalmology departement with profuse and purulent ocular discharge in both eyes with upper eye lid swelling. During the ophtalmic examination, the visual responses were normal . On slit lamp evaluation, the right cornea had a large paracentral epithelial defect measuring 5 mm horizontally and 6 mm vertically. The examination of the left eye also showed a central epithelial defect with underlying stromal infiltrate. The patient was started on Vancomycin (25 mg/ml) and ceftazidime (20 mg/ml) drops hourly . Cultures from both corneas grew methicillin-resistant Staphylococcus aureus (MRSA) within 48 h . The application of vancomycine solution was decreased to every 2 hours and then 6 times per day. The application of the ceftazidime oinment was stopped. He was also receiving vancomycin intraveinously. During the next 3 weeks, the epithelial defect totally resolved. Tbe patient was left with bilateral paracentral diffuse corneal opacity. Deep neutropenia was seen in repeated complete blood counts. Bone marrow aspiration revealed maturation arrest of the neutrophils. Granulocyte – Colony Stimulating Factor (G-CSF) (5 µg/kg) treatment was started with the presumed diagnosis of Kostmann syndrome . All ANC were 140 / mm3 without G-CSF. After G-CSF, ANCs increased up to just maximum 940 / mm3. Physical examination, growth and mental development were normal. Serum levels of immunoglobulins and lymphocyte subtypes were within normal ranges. In the investigation of genetic causes of severe congenital neutropenia, homozygous JAGN1 mutations were identified.

Patients with primary immune deficiency may develop infectious diseases of the ocular surface without any common risk factors for bacterial keratitis. Investigation for an infectious etiology should be performed and treatment promptly implemented when presented with conjunctival or corneal inflammation or ulceration.
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P146
WHEN CROSSLINKING GETS COMPLICATED
Tania Josalhène Elongo
Cornea
Tania Josalhène

ELONGO
Morocco
Corneal collagen crosslinking is a non-invasive technique that changes the biomechanical properties of the corneal stroma. It helps stop the progression of keratoconus.
This commonly performed surgery is not without risk and can lead to secondary corneal infection.
Corneal collagen crosslinking is a non-invasive technique that changes the biomechanical properties of the corneal stroma. It helps stop the progression of keratoconus.This commonly performed surgery is not without risk and can lead to secondary corneal infection.
Pediatric ophthalmologic department of hospital 20 aout 1953 of Casablanca in Morocco, university Hassan 2
We report the clinical observation of a 32-year-old female patient who presented with a painful right red eye following corneal collagen crosslinking.
32-year-old woman with Down's syndrome, followed for 6 months in our department for progressive bilateral keratoconus as well as allergic conjunctivitis.
She benefited from an epi-off corneal collagen crosslinking in her right eye, which went without incident.
On the 2nd postoperative day, she presented with a painful right red eye with purulent secretions.
On ophthalmologic examination we find three (3) epitheliostromal abscesses each measuring 1.6mm by 1.2mm
A corneal sample was taken, showing a coagulase negative staphylococcus.
The infectious risk factor found is the notion of eye rubbing in a patient who is not very complacent in the follow-up of hygiene rules.
The patient received treatment consisting of antibiotic therapy by injection, eye drops fortified with antibiotics, cycloplegia and then corticosteroid therapy.
The clinical course, two (2) weeks later, is marked by an almost total thinning of the cornea.

Patients who are candidates for crosslinking must benefit from close postoperative medical monitoring in order to be able to detect complications in time and manage them effectively.
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P147
RESULTS OF A CASE SERIES OF DSAEK (DESCEMET STRIPPING WITH AUTOMATED ENDOTHELIAL KERATOPLASTY) AT VIRGEN DE VALME UNIVERSITY HOSPITAL
Cristina Escorial Escorial Albendiz
Cornea
Cristina

Escorial Albéndiz
Spain
Our main objective is to describe the DSAEK procedure performed at the Virgen de Valme University Hospital and analyze the data obtained in the pre and post-surgical follow-up of 7 DSAEK cases in our center.
Series of 7 cases from the Virgen de Valme University Hospital in Seville (Spain).
7 patients with DSAEK were recruited. Outcome measures include visual acuity, biomicroscopy, and pre- and postoperative pachymetry.
6 of the 7 patients had visual acuity equal to or greater than 30% after DSAEK. 6 of the 7 patients suffered from Fuchs' dystrophy, the remaining patient suffered from corneal decompensation secondary to cataract surgery. Slit lamp examination 3 months after DSAEK revealed absence of rejection signs in 6 of 7 patients. Pachymetry was evaluated prior to surgery (24 hours before DSAEK) and after surgery (3 months after surgery): mean preoperative pachymetry was 628 microns and mean postoperative pachymetry using OCT was 723 microns.
DSAEK has clear advantages over classic penetrating keratoplasties, both in visual results, as well as in safety during surgery and recovery. Our group of patients presented mostly good visual acuity and recovery results. The anterior segment OCT is a useful tool in the surgical indication and also after surgery. Pachymetry can be obtained with different techniques, such as with anterior segment OCT, and it helps us to indicate and follow corneal transplants as well as their complications.
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P148
TO COMPARE THE LONG-TERM EFFECTS ON LENS, CORNEA AND ANTERIOR CAMERA IN PHAKIC PATIENTS WHO RECEIVED 3 DOSES OF INTRAVITREAL DEXAMETHASONE FOR RETINAL VEIN OCCLUSION
Mehmet TAHIR Eski
Cornea
Mehmet
TAHIR
ESKI
Turkey
To compare the long-term effects on lens, cornea and anterior camera in phakic patients who received intravitreal dexamethasone for retinal vein occlusion.
Progression follow-up was performed in all cases. Anova, Mann-Whitney U and Wilcoxon tests were used for statistical analysis.
Fifty-four eyes without any corneal pathology who underwent intravitreal dexamethasone (OZURDEX®; Allergan, Inc, Irvine, CA) implant due to retinal vein occlusion in our clinic were retrospectively analyzed. The phakic cases who had 3 injections in total were included in the study. Corneal thickness, lens thickness and anterior camera depth measurements were used before the injection, one month after the first injection, one month after the second injection, and one month after the third injection.
There was no statistical difference between the 3 groups in terms of preoperative corneal thickness, lens thickness and anterior camera depth (p>0.05).
There was no statistically significant difference between the averages of corneal thickness, lens thickness and anterior camera depth obtained from 3 intravitreal injections and measurements at the end of 3 months (p>0.05).
It is known that dexamazone has a cataract-increasing effect on the lens, constricting the anterior camera. In the Genava study with a single dose of ozurdex, it was reported that this effect was in the same direction but less. Differently, we wanted to see the effect of repeated doses of ozurdex in our study. In our study, we found that lens thickness increased in accordance with the literature, but repeated doses were not statistically significant and had no effect on corneal thickness, similar to the literature.
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P149
A COMPARATIVE AND MULTIVARIATE ANALYSIS ON THE LONG-TERM EFFECT ON INTRAOCULAR PRESSURE OF THE PENETRATING KERATOPLASTY VS DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY
Glenda Espinosa Barberi
Cornea
Glenda

Espinosa Barberi
Spain
Compare the long-term effect of PK with DSAEK on IOP and to identify the principal risk factors for the development of OHT.
In this cross-sectional and multivariate study all consecutive patients which had undergone corneal transplantation at Institut Catalá de Retina between 2008 and 2019 were included.

In the present study, 88 eyes from 80 patients were enrolled. Fifty-one eyes undergoing PK, with a mean follow-up of 67.1 ±43.7 months; and thirty-seven undergoing DSAEK, with a mean follow-up of 80.3 ±40.1 months.
The primary outcome measures were IOP change from baseline, number of hypotensive medications required to control IOP, complications and glaucoma procedures needed after corneal surgery. The secondary outcome measures were cumulative failure and rejection rate, change in BCVA and the duration of OHT.
The mean age of patients during surgery was 63.6 ±15.9 years, without significant differences between groups (p= 0.555).
The most frequent indication for corneal transplantation was bullous keratopathy and it was present in similar frequency in both groups (39.2 % in PK and 40.5% in DSAEK;p=0.89). History of glaucoma was noted in 21 eyes, 9 in the PK group and 12 in the DSAEK. A preoperative diagnosis of OHT was noted in 28 eyes, 15 in the PK group and 13 in the DSAEK group (p=0.141).
The IOP was significantly higher in the PK group at 1 week (p=0.002), but it value changed considerably trough the months of follow-up. No significant differences in mean IOP were found between group (p>0.05) during other followup visits. Twenty eyes (39.2%) in the PK group and 24 eyes (64.9%) in the DSAEK group developed a significant IOP raise (p=0.018).
The IOP peak occurred, as a mean, only a few days earlier in DSAEK group than in the PK group (81 ±75.7 days, p= 0.03), and the mean value on increase from baseline was 6.4 mm Hg (p=0.000).
The mean duration of IOP raise significantly longer in PK group (203.8 ±181.3 days) than in in the DSAEK group (121.9 ±139.7 days; p=0.006). Both groups showed a significant increase in topical hypotensive medication required from baseline values (p>0.05). Both groups showed a significant increase in topical hypotensive medication required from baseline values (p>0.05).
Our study confirmed the relation between history or glaucoma or OHT, previous eye surgery, lens status, punch size and log term topical steroid treatment after surgery and a higher risk for IOP raise.
In the long term, both groups were equal, although it must be taken into account that in the DSAEK group there was a higher percentage of eyes with glaucoma prior to surgery.
It should be noted that IOP raise seemed to happened a bit earlier in PK group, but both groups had similar IOP values at one month of follow-up. This is probably because the PK group undergoes a more aggressive surgery, with more intense inflammation and a probable remodeling of the irido-corneal angle.
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P150
HEIDELBERG ANTERION SWEPT-SOURCE OCT CORNEAL EPITHELIAL THICKNESS MAPPING: REPEATABILITY AND AGREEMENT WITH OPTOVUE AVANTI
YUE FENG
Cornea
Yue

Feng
Norway
To assess the repeatability of Corneal Epithelial Thickness Mapping (ETM) in virgin, post-laser refractive surgery (PLRS), and keratoconic eyes (KC), using a novel swept-source (SS) optical coherence tomographer (OCT), and to determine the agreement of the measurements with a validated spectral-domain (SD) OCT.
The Eye-department of the University Hospital North Norway, Tromsø, Norway
øyelegesenteret Eye Clinic, Tromsø, Norway
Analysis of 90 virgin, 46 PLRS and 122 KC eyes was performed. Three consecutive measurements of each eye were acquired with the Anterion SS-OCT and Avanti SD-OCT devices, and averages of the ETMs were calculated in the central 2 mm zone as well as in the 2-5 mm and 5-7 mm diameter rings. The repeatability was analyzed using pooled within-subject standard deviation (Sw). The agreement was assessed by Bland-Altman analysis and paired t-tests.
Repeatability of Anterion ETM measurements were: Sw: 0.60 - 1.36 μm. Anterion and Avanti 95% limits of agreement (LoA) were: 0.826 - 8.297. All the values of the thickness measurements with Anterion were lower than Avanti's, with the mean differences: 4.06 ± 1.81 μm, 3.26 ± 2.52 μm and 3.68 ± 2.51 μm in virgin, PLRS and KC eyes, respectively (p< 0.001 for all).
The repeatability of the Anterion's ETM was very high. The general agreement between the Anterion and Avanti was very good, however the epithelium measured by the Anterion was always thinner than Avanti, making their interchangeable use unsuitable without corrections.
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P151
SURGICAL TECHNIQUE FOR TREATMENT OF SYMBLEPHARON AND MASSIVE PANNUS IN A YOUNG PATIENT WITH EPIDERMOLYSIS BULLOSA DYSTROPHIC HALLOPEAU-SIEMENS
Berta Sánchez Fernández
Cornea
Berta
Sánchez
Fernández
Spain
To report our experience, surgical management, and results obtained with the use of amniotic membrane transplantation in a young patient with Epidermolysis Bullosa.
Hospital Universitario Virgen de la Victoria, Málaga. Spain.
A 16-year-old boy with epidermolysis bullosa dystrophic (EBD) Hallopeau-Siemens presented to our hospital with unilateral loss of vision and impossibility to open or close his left eyelid. Best-corrected visual acuity (BCVA) was 20/20 in his right eye (OD) and hand motion in his left eye (OS). There was a limitation of OS motility secondary to extensive symblepharon from the upper and lower temporal lids to central and temporal corneal area and adjacent bulbar conjunctiva. The affected cornea showed massive neovascularization and opacification. The patient was planned for surgery consisting of symblepharon resection, lamellar keratectomy, and excision of the scarred conjunctiva. An amniotic membrane was used to cover the whole cornea and the bulbar and palpebral conjunctival surface. It was sutured to the corneal margins with a continuous circular suturing with a 10-0 monofilament nylon. It was also sutured to the eyelid margin with interrupted 8-0 polyglactin (Vycril). A silicone fitting symblepharon ring without suture was used to maintain the fornices. It was made a frost suture and a botulinum toxin-induced protective ptosis as the final step of the surgery.
Six months after surgery, the patient recovered full ductions with no symblepharon presence. His visual acuity in OS was 20/70, and the corneal surface was devoid of pannus with some superficial scarring. Fornices were free and well-formed.
Our surgery technique described was found effective in the treatment of massive symblepharon secondary to this rare disease. We present the possibility of avoiding sutures in the fornices, and the usefulness of frost suture and botulinum toxin-induced protective ptosis to improve postoperative outcomes.

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P152
PENETRATING KERATOPLASTY AND SUTURED MORCHER INTRAOCULAR LENS IN A PATIENT WITH ANIRIDIA AND POST TRAUMATIC CORNEAL LEUCOMA, A CASE REPORT
Ronell Fernández Hernández
Cornea
Ronell

Fernández Hernández
Spain
To present a clinical case in which the simultaneous use of a penetrating keratoplasty and implantation of a sutured intraocular lens was used to treat a patient with posttraumatic aniridia and corneal leukoma.
Traumatic aniridia is a relatively infrequent condition in regular clinical practice. Due to its nature, it is usually accompanied by other ophthalmologic conditions such as corneal scars or corneal decompensations. Because of this, the treatment of these patients can be a daunting task with no definitive answer.
Report of a clinical case
We present the case of a 61 years old male patient referring low vision in his left eye. The patient had suffered a blunt force trauma to said eye 30 years prior which was initially surgically treated by suturing the corneal laceration, extraction of crystalline lens and extensive pars plana vitrectomy. No other surgical treatments were performed afterwards. Best corrected visual acuity was hand motion in his left eye. Anterior and posterior segment slit lamp examination of the right eye was normal. Slit lamp examination of the left eye showed the presence of a diffuse corneal leukoma as well as diffuse corneal oedema. Aphakia and sectorial aniridia, with only small segments of the iris remaining inferiorly and temporally, were also observed. Funduscopy exam of the left eye could not be performed due to corneal opacity. B mode echography showed correct positioning of the retina.
A surgical treatment was performed consisting of a combination of penetrating keratoplasty and the implantation of an aniridia type 67B Morcher intraocular lens by means of scleral fixation with a Prolene suture. This was made as a variation of the four-flanged technique of Sérgio Canabrava. Evolution of the patient following the procedure was correct, with a correct positioning of the lens and a good cosmetic result being observed afterwards.

This case allows us to show a different way of Morcher intraocular lens fixation, being different than the usual method, but still obtaining good stability and lens positioning a year following the procedure.
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P153
APPLICATION OF A NEW PROTOCOL FOR BAND KERATOPATHY TREATMENT WITH ETHYLENEDIAMINETETRAACETIC ACID (EDTA): A CASE SERIES
Catarina Cunha Ferreira
Cornea
Catarina
Cunha
Ferreira
Portugal
To evaluate the effectiveness and safety profile of a simple and easy to obtain in daily clinical practice ethylenediaminetetracetic acid (EDTA) solution for the treatment of calcific band keratopathy.
Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
A prospective case series was conducted including patients with calcific band keratopathy diagnosis. A simple protocol for EDTA solution preparation was followed, according to previous literature: a purple-topped 10-mL K2EDTA Vacutainer blood collection tube containing 18 mg of K2EDTA was used; after tube cap removal, 0.3 mL of sterile water was injected into the tube containing; then a sterile cotton–tipped applicator was used to absorb the fluid, followed by sweeping of the interior surface of the tube to dissolve the K2EDTA coating the inside, creating an EDTA solution.
A total of 3 patients were enrolled. Patient 1 was a 79-year-old man and patient 2 an 82-year-old woman, both with idiopathic band keratopathy. Patient 3 was a 21-year-old man with band keratopathy secondary to chronic ocular inflammation. All patients presented with symptomatic band keratopathy affecting the visual axis. Treatment procedure involved corneal epithelium removal with alcohol 15% solution, recurrent application of topical EDTA solution obtained as previously described, and subsequent debridement. An amniotic membrane transplant was performed in patients considered to be at risk for persistent epithelial defect. Close follow‐up of the patients was assured after the procedure and anterior segment photos were taken in each visit, demonstrating a good anatomical response and visual acuity maintenance or improvement after treatment.
Calcific band keratopathy is a degenerative corneal disease that primarily affects the Bowman layer, characterized by fine calcium opacities which form a horizontal band towards the central cornea. EDTA is the most widely used treatment, acting as a calcium chelating agent, and was originally derived from Na2EDTA. Given the necessity of specially equipped pharmacies to obtain this agent, simple and easy protocols are needed for routine clinical practice. In this case series, we used a recently published protocol for K2EDTA obtention which proved to be easily available and effective for the treatment of band keratopathy.
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P154
COMPARISON OF TWO OPTICAL COHERENCE TOMOGRAPHY DEVICES IN CORNEAL EPITHELIAL THICKNESS MAPS
Andreea Fisus
Cornea
Andreea

FISUS
Austria
Aim of this study is to assess agreement and repeatability of epithelial thickness measurements using two optical coherence tomography devices in healthy and keratoconus eyes. Secondary objective was to evaluate the differences between healthy and keratoconus eyes using these epithelial thickness map data.
Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria
In this prospective monocentric study that included patients divided into two groups: patients with keratoconus, the study group and a control group of patients without corneal pathologies scheduled for cataract surgery. For each patient only one eye was included and corneal measurements were performed, focused on the corneal epithelial thickness. Two devices were used in the study: the Anterion (Heidelberg Engineering) using swept-source optical coherence tomography and the MS-39 (CSO) using spectral domain optical coherence tomography combined with Placido disc topography. The corneal epithelial thickness was measured as the distance between the air-tear and the epithelium-Bowman interfaces. Each patient was measured three times with both devices. The order of measurements was randomised.
In total 50 eyes of 50 patients were included, comprised of 20 eyes with diagnosed keratoconus and a control group with 30 healthy corneas. The mean age of patients included in the study group was 40.9 ± 14.6 and 69.8 ± 10.4 for the control group. The MS-39 showed a high repeatability in both keratoconus and healthy eyes. Final results will be presented.
Anterior segment OCT appears to be a valuable tool for assessing epithelial thickness in human eyes. The reproducibility of the thickness measurements was found to be high.
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P155
OPIOID SYSTEM AND OCULAR SURFACE PAIN
Celia García-López
Cornea
Celia

García López
Spain
This review attempts to collect the literature about corneal surface and opioid pathways to provide an overview image and a possible direction of the new treatments.
Single tertiary center, University Hospital Virgen de las Nieves, Granada, Spain.
A Pubmed search was conducted for relevant studies on the physiopathology of role of opioids on the cornea and the use of opioids for treating ocular surface problems. The search was for studies published from 1990 to 2021, including basic sciences studies, randomized clinical trials and reviews. Inclusion criteria of this narrative review were focused on the function of opioids controlling different types of pain and new vias of treatment.
In daily use, systemic opioids are used as painkillers. The use of weak opioids such us codeine or tramadol have decreased the associated side effects. Corneal surface for topical treatment is easily accessible hence sparing the side effects of systemic opioids. Topical opioidstreatments such us morphine or codeine have been accomplished for the control of postoperative and inflammatory pain with mixed incomes. Especially in centralized pain, oral low dosage of naltrexone produces a rebound effect of endogenous opioidsachieving an analgesic effect and other protentional benefit in dry eye and neuropathic pain. The inhibition of catabolic enzymes of endogenous opioids in the cornea enables to increase the natural opioid actions and new and specific agonists, especially MOR agonists, expand the possibilities to enhance the analgesia.
In the cornea, opioid system has a role in the control of the different stages of the pain. The manipulations of these pathways, with antagonists or agonists oral opioids and topical treatment, imply a new vias of controlling it, especially in neuropathic pain.
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P156
CLINICAL RESULTS OF PATIENTS WITH FUCHS ENDOTHELIAL CORNEAL DYSTROPHY TREATMENT WITH HEMI-DESCEMET’S MEMBRANE ENDOTHELIAL KERATOPLASTY
Aslan Geliastanov
Cornea
Aslan

Geliastanov
Russian Federation
To report the 1-year clinical outcomes of using a semicircular Descemet membrane graft (hemi-DMEK) performed for Fuchs endothelial corneal dystrophy (FECD).
S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
Prospective, interventional case series assessing the outcomes of 24 eyes from 24 patients who underwent hemi-DMEK combined with phacoemulsification and IOL implantation for FECD. Best-corrected visual acuity (BCVA), endothelial cell density (ECD) and central corneal thickness (CCT) were measured prior to surgery and up to 12 months after the procedure.
Hemi-DMEK was successful in 23 out of 24 eyes; one eye required repeated keratoplasty. BCVA improved in all successful hemi-DMEK cases: at 12 months 86 % of eye (n=20) reached = 0.5, 47% (n=11) = 0.8 and 26% (n=6) reached = 1.0. Compared to preoperative measurements, mean ECD decreased from 2850(±84) cell/mm2 preoperatively to 1285±277 cell/mm2 (n=20) at 1 year. Average CCT decreased from preoperative 650±44 um to 519±43 um (n=20) at 1 year postoperatively.
Hemi-DMEK provide favorable visual outcomes comparable to those achieved by standard DMEK. The graft survival rate complication profile turn out to be similar to standard DMEK. Hemi-DMEK might be a good option to treat patients with tep endothelial pathology, and having a potential to increase the availability of donor tissue for endothelial keratoplasty (one cornea for 2 patients).
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P157
FEASIBILITY AND OUTCOMES OF CONCOMITANT ENDOSCOPY-ASSISTED TOTAL PARS PLANA VITRECTOMY IN BOSTON KERATOPROSTHESIS TYPE 1
Dominique Geoffrion
Cornea
Dominique

Geoffrion
Canada
Vitreoretinal complications after Boston keratoprosthesis type 1 (Boston KPro) lead to severe visual loss but can be decreased with total pars plana vitrectomy (PPV) at the time of Boston KPro implantation. However, anterior hyaloid peeling during PPV is challenging without endoscopy. The purpose was to report on the feasibility of the first-ever case of total PPV, with anterior hyaloid peeling assisted by endoscopy, performed at the time of Boston KPro surgery.
Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
First case of Boston KPro and endoscopy-assisted anterior hyaloid peeling performed as part of a prospective, interventional study. Clinical and surgical reports from before and after surgery were reviewed, including history, best-corrected visual acuity (BCVA), intraocular pressure (IOP) by digital palpation, optical coherence tomography (OCT), and B-scan ultrasonography, over a 2-month period. Intraoperative observations and results were reported. A thorough review of the literature was also performed.
A 60-year-old male, with a history of two previously failed penetrating keratoplasties after ocular perforation with plugged iris in his left eye, was deemed eligible to benefit from both Boston KPro and PPV. Preoperative evaluation was limited through the opaque-diseased cornea. BCVA was light perception (LP), no retinal detachment was seen on B-scan, and IOP=26mmHg on 3 glaucoma drops. On the day of surgery, the unstable intraocular lens was removed and synechiae lysed. A Boston KPro was implanted, and a 3-port 23-gauge PPV was achieved with visualization through the Boston KPro optic and wide-angle viewing system, without a temporary KPro. Anterior hyaloid peeling and removal of capsule remnants were completed using endoscopy. Endoscopic intraoperative assessment revealed severe cupping suggestive of already advanced glaucoma, with the posterior pole, peripheral retina, and retinal vessels within normal limits. A soft contact lens was applied. The patient was put on prednisolone and moxifloxacin drops four times daily. One week later, BCVA was hand motion (HM) and IOP=28mmHg on maximal tolerated medical therapy (MTMT). Two months later, BCVA remained LP, IOP=20 mmHg on MTMT, and the Boston KPro optic remained clear, with no retroprosthetic membrane (RPM), no cells in the anterior chamber, and intact sutures. Preexisting advanced glaucoma was only diagnosed once a clear optic was in place, hence little improvement in BCVA.
Endoscopy at the time of Boston KPro implantation offers a rare in-situ view of the Boston KPro and retroiridal structures, as well as complete removal of the anterior hyaloid. This combined procedure, reported herein for the first time, can be achieved in Boston KPro candidates with vitreoretinal diseases, shortening operative time. By removing such proinflammatory membranes, the incidence of glaucoma progression, retinal detachment and RPM may be decreased and improve visual outcomes for patients.
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P158
PERSPECTIVES FOR THE DEVELOPMENT OF PRECLINICAL MOUSE MODELS OF GLAUCOMA AFTER BOSTON KERATOPROSTHESIS TYPE 1
Dominique Geoffrion
Cornea
Dominique

Geoffrion
Canada
To determine the feasibility of establishing a reproducible mouse model of glaucoma after Boston keratoprosthesis type 1 (KPro) surgery, specifically that of a miniaturized mouse model of KPro (mKPro).
Centre de recherche du Centre hospitalier de l'Université de Montréal (CR-CHUM), Montreal, QC, Canada
A total of 20 corneas of donor C57BL/6 mice (n=10) were implanted in one eye of each recipient BALB/C mice (n=20), assembled as part of the mKPro, either with or without intraoperative lensectomy. Main feasibility outcomes consisted in incidence rates of hypotony, capsule nicking, and lens extrusion, as well as acquisition of posterior segment OCT images.
With lensectomy (n=10), loss of ocular tone and rhegmatogenous retinal detachment occurred in 100% of mice. Without lensectomy (n=10), capsule nicking and opening, as well as lens extrusion, occurred in 80% of mice. Causes of these complications included the large proportion of intraocular volume occupied by the lens, the shallow anterior chamber, and thus the lack of available intraocular volume to implant the KPro if the lens remains present.
Successful mKPro surgery may require a great deal of practice to be useful as a reproducible model in mice. An animal model with a larger eye ought to be prioritized by research teams in future studies.
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P160
SEQUELS OF SEVERE VERNAL KERATOCONJUNCTIVITIS (KCV): ABOUT A CASE
Zineb Hammoumi
Cornea
Zineb

HAMMOUMI
Morocco
The aim of our study is to show the value of an early diagnosis of vernal keratoconjunctivitis and rapid management to avoid the major consequences of this pathology on the eye and the psychic.
Pediatric ophtalmology department. Hospital 20 august 1953. Casablanca. Morocco.
Our study concerns a single case of a young patient of 15 years, resident in a rural environment, having as history of itching and redness of the eye since childhood never having consulted an ophthalmologist. Having consulted for a major, disabling photophobia, with tearing and significant ocular pruritus, associated with a decline in bilateral visual acuity affecting the patient's education.
The ophthalmological examination shows a visual acuity of 3/10 in the right eye and 2/10 in the left eye. At the appendages there is conjunctival hyperaemia, giant papillae and nodules of limbic Trantas at the level of both eyes. At the anterior segment, a raised vernal plate occupies the upper 1/3 of the cornea, with 360° neovessels and a clear lens at the level of both eyes. The fluorescein test results in a diffuse superficial punctuated keratitis in both eyes. It is a bilateral vernal keratoconjunctivitis of mixed form (palpebral and limbic) complicated of corneal involvement stage 3 according to the Cameron classification. Therapeutic management: Scraping of the plaque at the scarifier in the operating room under topical anesthesia, anti-allergic treatment (Antihistamine and Mastocytic Antidgranulant), eye wash solutions, Wetting and healing corneal agents without preservatives and corticosteroids strengthened local then ciclosporin eye drops 1%:2 drop/ day with an allergy assessment. The evolution was marked by a regression of pruritus and photophobia with decrease of conjunctival hyperaemia with persistence of a corneal opacity sequellary associated with neovascularization.
Vernal keratoconjunctivitis is a clinical form of eye allergy that can induce major visual complications. The disabling functional signs of inflammatory outbreaks have a major impact on the lives of children and parents. It can be a source of drop-out, anxiety and behavioural disorders, hence the interest of psychological support for the patient.
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P161
PERIPHERAL ULCERATIVE KERATITIS ASSOCIATED WITH MULTIPLE POSSIBLE INFECTIOUS ETIOLOGIES
Antonio Hernández-Pons
Cornea
Antonio

Hernández-Pons
Spain
To discuss the occurrence and management of peripheral ulcerative keratitis associated with multiple possible infectious etiologies.
We report the case of a 40-year-old man from Senegal who presented with severe pain, redness, and photophobia in his left eye since last three months. His local practitioner had prescribed him a topical antibiotic ointment but saw no improvement. Slit-lamp biomicroscopy revealed an area of stromal thinning at the limbus associated with neovascularization and epithelial defect. Fundus examination was normal and intraocular pressure was 12 mmHg. He was diagnosed with peripheral ulcerative keratitis and topical treatment was introduced (moxifloxacin q8h and artificial tears drops).
He denied any autoimmune disease, but referred history of vegetal trauma months ago. Corneal scrapings were collected for polymerase chain reaction (PCR) and culture testing. The patient underwent complete laboratory examination and systemic evaluation, as well as chest radiograph and interferon-gamma release assay (IGRA).
Microbial cultures were negative, but PCR detected varicella-zoster virus DNA in the corneal stroma. The rapid plasma reagin and the fluorescent treponemal antibody absorption tests were positive. Moreover, the IGRA test for tuberculosis infection was also positive, although the chest X-ray was negative for pulmonary tuberculosis. Evaluation for autoimmune etiology showed negative results. The patient was treated with oral valacyclovir 1000 mg three times daily, intramuscular penicillin G benzathine, and antituberculous therapy (isoniazid, rifampin, pyrazinamide, plus ethambutol). Despite the systemic treatment, there was no improvement, the ocular pain got worse, and the ulceration progressed circumferentially with high risk of corneal perforation. Finally, he was managed with the use of systemic and topical corticosteroids, as well as excising the limbal conjunctiva adjacent to the ulcer. The response to the treatment was good and the ulcer began to heal. The patient was followed up regularly and topical 0.05% cyclosporine A was used as a maintenance drug to prevent recurrence.
Peripheral ulcerative keratitis associated with infectious etiology is rare, but in confirmed cases we must initiate specific antimicrobial treatment. However, as it is an immune-mediated phenomenon, it may be necessary to use immunomodulators to control the inflammatory process.
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P162
XENIA IMPLANT - THE STORY SO FAR
Balasubramaniam Ilango
Cornea
Balasubramaniam

Ilango
United Kingdom
To study the long term effects of Xenia Implant in restoring normal anatomy of cornea in patients suffering from keratoconus and Post Lasik ectasia
Xenia Implant made from porcine collagen and supplied by Gebauer
Optimax Lser Eye Clinic, Leicester, UK
Prospective study of keratocnus and post lasik ectasia patients who underwent Xenia implantation over a period of 2 years
10 eyes of 10 patients
Intralase Femtosecond Laser stromal pocket created at 100 to 130 microns deep, 8.7 mm dimater, 3.7 mm access port. Gebauer Lenticule of varying thicknesses were used (75 to 120 microns) Pre and post operative vision, corneal thickness, corneal curvatures were measured. Antibiotics and steroid eye drops were used postoperatively

Average cornea thickness increased from 350 to 513 microns; average corneal astigmatism decreased from 7.4 D to 2 D. Unaided vision improved from 1.74 LogMar to 1.54 LogMar
Tkicker Xenia implants have a tendency to opacify while thinner version remains transparent
Keratoconus and post lasik ectasia patients have only a few treatment options of which Xenia Implants seems to offer promising results
The newer version of Xenia (75 microns) tends to remain transparent resulting in better visual outcome
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On-demand

P163
PSEUDOMONAL KERATITIS IN SOFT CONTACT LENS WEARER : ABOUT TWO CASES
Moctar Issiaka
Cornea
Moctar

issiaka
Morocco
Report of two cases of unusual pseudomonal keratitis associated with the use of daily silicone hydrogel contact lenses.
Microbial keratitis is potentially sight-threatening and has long been strongly associated with contact lens wear. Even with fully comply with care and wearing. Studies and laboratories had linked overnight wear to an increased risk of microbial keratitis,also the use of low-Dk hydrogel contact lenses by creating significant corneal hypoxia.
Two cases who developed culture-positive keratitis linked to pseudomonas aeroginosa, despite consistent daily wear of hydrogen silicone lenses.
The 2 patients had no significant risk factors. The first case involving a 31-year-old woman who reported consistent and infrequent use of daily silicone hydrogel contact lenses presented with a rapid onset after just 2 months. The culture was positive for pseudomonas aeruginosa. The corneal ulcer was successfully treated with a fortified antibiotic, the best corrected visual acuity of 14/20 was reached after 6 weeks, despite the persistence of sequellar stromal opacity. The 2nd case is a 29-year-old woman who had been using conventional soft contact lenses, before switching to daily disposable silicone hydrogel contact lenses, for a maximum daily wear of 8-10 hours, developed severe keratitis in his left eye after 4 months of wearing. The evolution was marked by the extension of the abscess and a corneal perforation despite the maximum treatment from the outset. She obtained a transfixing keratoplasty allowing to obtain a better final visual acuity corrected to 8/20.
Even rare, microbial keratitis remains a serious and potentially blinding complication of contact lens wear. P. aeruginosa is the most frequent organism implicated in contact lens-related keratitis,requiring rapid,intensive ,and adequate treatement. The clinical performance and advenced materials of silicone hydrogel lenses used on a daily-wear had reduced many hypoxic complications.
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P164
A NEW METHOD OF TREATING PROGRESSIVE KERATOCONUS BY FEMTOSECOND KERATOTOMY
Svetlana Borisovna Izmailova
Cornea
Svetlana
Borisovna
Izmailova
Russian Federation
The purpose of this study is to evaluate the results of experimental femtosecond radial keratotomy using Russian laser 'Femto Visum' on the cadaver eye. The technical feasibility of this method, the quality of this procedure, and the histological structure of the preparation obtained from the cornea of the cadaveric eye were evaluated.
A method for the treatment of keratoconus I-III grade has been developed, the essence of which consists in applying 4-12 stromal corneal incisions using a femtosecond laser in the annular corneal zone with an external diameter of 8-11 mm, an internal diameter of 5-6. 5 mm; the length of the incisions is equal to the width of the annular zone, the depth of the incision is 75% of the thickness of the cornea in the incision application zone, with a distance from the anterior surface of the cornea of 60 microns.
A femtosecond laser FemtoVisum was used to perform 8 radial incisions in the annular area of the cornea with an external diameter of 9.5 mm, internal 5.0 mm for the following parameters: wavelength 1030-1040 nm, pulse duration 300-400 fs, pulse repetition rate 1 MHz, pulse energy 0.75 mJ, focus spot size< 2 µm. The thickness of the cornea of the cadaveric eye was 900 µm. The distance from the anterior surface of the cornea was 60 µm. The depth of the incisions was 675 µm. Departure from the anterior corneal surface was necessary to assess the possibility of precise laser incision in the anterior corneal layers, which is necessary for future dissection of the Bowden's membrane with preservation of the epithelial layer integrity. The necessity of this step is due to the fact that until now, none of the foreign companies involved in the production of femtosecond lasers has been able to create software for conducting metered-dose, different in location, number and depth for the treatment of patients with keratoconus, as well as any other refractive operations, including in patients with myopia and thin cornea. After radial incisions were made on the eyes, a pentacam device was used to examine them. A total of 10 cadaveric eyes were operated on. 5 with an indentation of 60 µm from the surface. 5 without indentation with damage to the epithelium.
Radially symmetrical equidistant incisions were successfully performed. The central and limbal corneal areas remained intact. There were no gas bubbles in the anterior chamber, which indirectly indicated the integrity of the descemet membrane.
According to the results of histology, the success of surgical intervention was revealed. The stroma was dissected to a predetermined depth, all the incisions remained an indent from the anterior surface of the cornea, and no corneal incision was observed in any of the incisions.
A new promising method for treating progressive keratoconus using a femtosecond laser, which has no analogues in the world, has been developed. The technical feasibility of this procedure is confirmed by experimental results and histological examination data.
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P165
DRY EYE ASSESSMENT IN JORDAN DURING COVID-19 PANDEMIC
Bahaa aldin Jaber
Cornea
Bahaa
aldin
jaber
Jordan
The study aims at assessing the dry eye profile in a cohort of the Jordanian population using an online questionnaire-based survey.
Main Outcomes and Measures: From March to May 2020, we conducted an online questionnaire-based survey to assess dry eye in the community of Al-Ahliyya Amman University for optometry students and their family members with dry eye who spent more time at home in front of digital devices due to the COVID-19 pandemic. The questionnaire consisted of demographic profile along with questions based on: (a) Frequently occurring symptoms of dry eyes. (b) Frequency and severity questions. (c) Environmental triggers and medications used, and (d) The Ocular Surface Disease Index (OSDI).
Main Outcomes and Measures: From March to May 2020, we conducted an online questionnaire-based survey to assess dry eye in the community of Al-Ahliyya Amman University for optometry students and their family members with dry eye who spent more time at home in front of digital devices due to the COVID-19 pandemic. The questionnaire consisted of demographic profile along with questions based on: (a) Frequently occurring symptoms of dry eyes. (b) Frequency and severity questions. (c) Environmental triggers and medications used, and (d) The Ocular Surface Disease Index (OSDI).
Results: Out of 200 online questionnaires, 185 responses were received. The mean age was 35.08 ±12.13 years (range. There were 89 (48.1%) men and 96 (51.9%) women. The male: female ratio was nearly 1:1. The mean OSDI in the population cohort was 11.69 ± 8.16. The mean scale of various dry eye symptoms ranged from 10.5 to 11 approximately. There was a significant gender difference regarding the frequency of dry eye (p= 0.005), where 58 (60.4%) of women had dry eye compared to 36 (40.4%) of men. There was no significant age difference regarding dry eye (p=0.295).
Conclusions and Relevance: Due to COVID-19 pandemic, the dry eye disease escalated among the Jordanian population of optometry students and their families. This will impact the symptom profile, day to day performance, and also add to the burden of dry eye in society.
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P166
ASSESSMENT OF THE CONCENTRATION OF SELECTED METALLOPROTEINASES IN THE CORNEAL EPITHELIUM IN PATIENTS WITH RECURRENT CORNEAL EROSIONS UNDERGOING THERAPEUTIC PHOTOKERATECTOMY
Katarzyna Jadczyk-Sorek
Cornea
Katarzyna

JADCZYK-SOREK
Poland
Assessment of the differences in the concentration of selected matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9) in the corneal epithelium between: (1) patients with recurrent corneal erosions (RCE) caused by trauma or Cogan's microcystic dystrophy, and patients with stable epithelial-stromal complex (2) patients with post-traumatic RCE and patients with RCE due to Cogan's microcystic dystrophy.
Department of Ophthlamology, Department of Biochemistry
The analyzed group included 121 eyes in 121 patients classified into the study and control groups, respectively. The study group (group 1) included 56 eyes in 56 patients qualified for the phototherapeutic keratectomy (PTK). The criterion for the division group 1 into two subgroups A and B was the etiology of RCE: group 1A - Cogan's basement membrane dystrophy (n=22 people) and group 1B - trauma (n=34 people). The control group (group 2) included people with a stable epithelial-stromal complex who underwent Epi-Bowman Keratectomy (EBK). Control group included 65 eyes in 65 patients. The analyzed material was the corneal epithelium collected during the PTK or EBK, respectively for the study and control groups. MMP concentration was determined by immunohistochemical method using Human Magnetic Luminex® Assay.
Assessment of the concentration of MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9 in the corneal epithelium in patients with RCE, revealed: (1) statistically significant higher concentration of MMP-2 in the group of patients with RCE compared to the control group, which was on average 967.0±1084.9 in patients in group 1 and 175.7±121.2 in patients from group 2 (2) statistically significantly higher concentration of MMP-3 in the group of patients with RCE compared to the control group, which averaged 281.7±471.6 in patients in group 1 and 21.5±33.2 in patients from group 2 (3) no statistically significant differences in the concentration of MMP-2 and MMP-3 between subgroups 1A and 1B, but a higher concentration of MMP in group 1A (4) the inability to assess the concentrations for MMP-1, MMP-7, MMP-8, MMP-9 in groups 1 and 2, due to the too low sensitivity of the MMP test kits.
Assessing the differences in the concentration of selected MMP in the corneal epithelium, it was found: (1) statistically significant higher concentration of MMP-2 and MMP-3 in the group of patients with RCE due to trauma and Cogan's microcystic dystrophy compared to patients with stable epithelial stromal complex (2) higher concentration of MMP-2 and MMP-3 in the epithelium of patients with Cogan's microcystic dystrophy compared to the group of patients after the injury, however, these differences turned out to be statistically insignificant. Despite the use of the highest sensitivity kits available, both in the group of patients with RCE and in the group of patients with a stable epithelial-stromal complex, concentrations for MMP-1, MMP-7, MMP-8, and MMP-9 were not sufficient for analysis.
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P167
SCHEIMPFLUG CORNEAL DENSITOMETRY OF CORNEAS AFTER DMEK COMPARED TO HEALTHY CORNEAS: 5 YEARS FOLLOW UP
Nikolaos Kappos
Cornea
Nikolaos

Kappos
Greece
To compare corneal densitometry (CD) following uneventful Descemet membrane endothelial keratoplasty (DMEK) with healthy corneas throughout 5 years follow up.
To compare corneal densitometry (CD) following uneventful Descemet membrane endothelial keratoplasty (DMEK) with healthy corneas throughout 5 years follow up.
Medical records of 212 consecutive surgeries were reviewed. Sixty cases without intraoperative and postoperative complications were included (group 1). Scheimpflug CD of the 0- to 2-mm zone, 2- to 6-mm and 6- to 10-mm annulus were evaluated preoperatively and at 3, 6, 12, 24, and 60 months postoperatively. All results were compared with an age matched group of uncomplicated pseudophakic eyes (group 2; n =20) and a group of healthy, young subjects (group 3; n = 30).
Total CD at 0 to 2 mm was 33 ± 10 grayscale units (GSU) preoperatively and decreased to 21.8 ± 3.1 GSU at 60 months (p<0.001), being significantly higher compared with both control groups (p ≤ 0.043). Total CD at 2 to 6 mm was 27.8 ± 8 GSU preoperatively and decreased to 22.2 ± 4.2 GSU at 60 months (p<0.001), showing statistically significant difference compared with both groups (p ≤ 0.016). Total CD at 6 to 10 mm was 30 ± 8.3 GSU preoperatively and increased to 34.6 ± 7.8 GSU at 60 months (p<0.001), showing no statistically significant difference compared with group 1 (p ≥ 0.093).
Total CD at 0 to 2 mm was 33 ± 10 grayscale units (GSU) preoperatively and decreased to 21.8 ± 3.1 GSU at 60 months (p<0.001), being significantly higher compared with both control groups (p ≤ 0.043). Total CD at 2 to 6 mm was 27.8 ± 8 GSU preoperatively and decreased to 22.2 ± 4.2 GSU at 60 months (p<0.001), showing statistically significant difference compared with both groups (p ≤ 0.016). Total CD at 6 to 10 mm was 30 ± 8.3 GSU preoperatively and increased to 34.6 ± 7.8 GSU at 60 months (p<0.001), showing no statistically significant difference compared with group 1 (p ≥ 0.093).
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P168
A CASE REPORT
TREATMENT OF HERPETIC KERATITIS WITHOUT USING ANTIVIRAL MEDICINES
Anastasia Karagianni
Cornea
Anastasia

Karagianni
Greece
To present a case of herpetic keratitis, where antiviral therapy was not used (locally or systemically).
Material and method: A 66-year-old woman came to the ICU of our clinic, causing sudden pain, photophobia, intense tearing, blurred vision and intense feeling of a foreign body.
Individual history (Breast Ca 10 years ago, a congenital kidney and fatty infiltration of hormonal etiology. He also reported that he often developed herpes zoster on the upper right lip).
Findings from the clinical examination: Visual acuity ΔΟ (with correction) 6/10,AΟ 10/10 (with correction). Slit lamp examination: photophobia, tearing, conjunctival hyperemia, EEG measurement with Goldmann leveling tonometer DO: 12mmHg and AO: 11mmHg, susceptibility test (+) from 4-6 hours, without reaction in the anterior chamber and intense dry eyes (BUT ΔΟ 3sec andAΟ 5sec).
Due to the patient's individual history, it was impossible to use any form of antiviral therapy. Therefore, autologous serum eye drops (ASED) were prepared, without dilution, with instruction for instillation of one drop per hour. This serum contains bioactive elements such as albumin, lysozyme, vitamin A and growth factors (TGF-b, EGF), which promote healthy cell growth and healing of the ocular surface and cornea. A tobramycin eye ointment was also added three times a day.
Review in 48 hours. During the review the clinical picture was improved, with a reduction in symptoms. In the five days after the initial infection, the patient shows only mild conjunctival hyperemia, elimination of the dendritic ulcer and the improvement of the image of the intense dry eye. The local treatment was modified at each review.
The beneficial effects of autologous serum on the growth of health cells and the healing.
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P169
CHANGES IN CORNEAL DENSITOMETRY AFTER CORNEAL CROSS-LIKING IN KERATOCONUS
Reham Fattoh Ahmed Khalil
Cornea
Reham
Fattoh Ahmed
Khalil
Egypt
To detect changes in corneal density after corneal CXL for keratoconus
Future center for cornea and refractive surgery, Sohag, Egypt
30 eyes with KC stage II were included. Corneal densitometry of Oculus corneal topographer was performed preoperative and 3 months postoperative. All eyes underwent Epi-off CXL.
Primary outcomes: corneal densitometry cahnges.
9 eyes showed statistically significant increase in corneal densitometry. 14 eyes showed an increase in corneal density but it was statistiaclly insignificant. The remaining 7 eyes showed no changes in corneal densitometry.
Epi-off Corneal CXL for keratoconus is associated with significant changes in corneal densitometry
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P170
PENETRATING KERATOPLATSTY IN CHILDREN
Adéla Klézlová
Cornea
Adéla

Klézlová
Czech Republic
Pediatric penetrating keratoplasty is a rare surgical procedure, yet it has an irreplaceable role for some indications. There are differences compared to the surgery performed on adults, in the indications, in the surgical procedure, in postoperative management and also in the common complications and their treatment.
Case reports
The author of the lecture introduces the listeners to the issue of pediatric penetrating keratoplasty. The lecture will include two case reports of pediatric patients with a congenital corneal disease documented by video presentation.
The prognosis, perioperative and postoperative course of keratoplasty in children shows many differences compared tokeratoplasty in adults. Primary disease, often congenital and those affecting other eye tissues, play an important role in the corneal transplantation indication. The specific risk of postoperative complications and the time factor of the operation effect are important in the decision-making process, and additionally the risk of amblyopia needs to be considered. The operation itself usually differs from those performed on adult patients in the size of the transplanted part of the cornea or in the strategy of the graft suture. The postoperative course also has its specific complications, especially the more frequent transplant failure and the need for regrafting or secondary glaucoma. The whole situation is often complicated by the limited cooperation of the patients, who make the indication examination, postoperative monitoring as well as the diagnosis and resolution of complications more difficult.

Pediatric penetrating keratoplasty has its pitfalls associated with the often-unfavorable prognosis of primary diseases, more complicated perioperative and postoperative course, high demands placed on the surgeon and uncertain results. Nevertheless, in some cases, it is the only hope for at least a partial improvement in visual function for the young patient.

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P171
BILATERAL KERATOCONUS WITH OCULOCUTANEOUS ALBINISM
Saida Laababsi
Cornea
Saida

Laababsi
Morocco
The aim of our work is to present a very rare case of bilateral keratoconus in oculocutaneous albinism which has not been reported recently in literature.
Adult ophthalmology department, hospital August 20, Casablanca, Morocco
A 23 year-old albino male, a known case of oculocutaneous albinism (OCA) type 1a, presented to us with diminution of vision since his childhood with deterioration for the past six months, a frequent eye rubbing and photophobia. He had no family history. On physical examination, he was seen to have light dewy skin and light white hair. On ophthalmological examination, both eyes were found to have visual acuity (he was able to see the number of fingers held close to her face), horizontal pendular nystagmus, right esotropia, and a positive Munson&prime;s sign in both eyes. On slit lamp examination, his cornea showed thinning with conical protrusion in both eyes (the right more than the left), bilateral stromal scarring, Fleisher&prime;s ring, and Vogt&prime;s striae.
The anterior surface corneal topography of the right eye has showed a maximum keratometry readings of 79.3 diopter in right eye and 62.5 diopter in the left eye. Corneal pachymetry measurements at the thinnest locations were 428 microns and 464 microns for the right and left eye, respectively. The patient is a condidact for keratoplasty.
Keratoconus is a progressive corneal disease with an onset typically in teenage years. While it often presents as an isolated condition, keratoconus may also be associated with many systemic and/or ocular diseases, such as oculocutaneous albinism.
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P172
DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK) TO RESCUE FAILED PENETRATING KERATOPLASTY
Ricardo Machado Soares
Cornea
Ricardo José Dos Santos

Machado Soares
Portugal
To describe the results of Deep anterior lamellar keratoplasty (DALK) to rescue failed Penetrating Keratoplasty (PK) grafts through a case series of patients highlighting particular clinical pearls of this procedure.
Fernández-Vega Ophthalmological Institute, Oviedo, Spain
Retrospective, case-series analysis of patients who underwent DALK to rescue PK graft failure (GF) due to anterior corneal pathologies. Patients could not present any signs of endothelial immunological allograft rejection, endothelial failure, or endothelial corneal scars and had a follow-up superior to 6 months. The main objective of the surgery, and primary outcome of this study, was the improvement of corneal transparency and best-corrected visual acuity (BCVA). Intra and postoperative complications or events during follow-up were also reported. Corneal topography (Sirius, CSO®, Italy), anterior segment optical coherence tomography, and corneal pachymetry (Casia SS-OCT version 2, Tomey®, Nagoya, Japan), specular microscopy (CEM-530, Nidek®, Japan) as well as patients' surgery videos and anterior segment photographs, were obtained.
Four eyes, three patients (51-63 years of age) were included in the study. Every patient achieved a significant improvement in corneal transparency and BCVA that lasted throughout the follow-up. Two intraoperative complications were observed: a small Descemet's membrane peripheric micro-perforation in one patient, which was easily tamponaded, and an opening of the previous graft-host junction in another patient, which was readily solved by adding more sutures in that area. During follow-up, no patient presented any signs of GF or graft rejection.
Repeated PK has a poorer prognosis compared to primary PK due to endothelial rejection. Our results suggest that DALK in these cases is surgically feasible. Lamellar surgery preserving a still healthy endothelium could be a promising approach for failed PK grafts due to anterior corneal pathologies. To our knowledge, our study is the first worldwide to report the use of DALK to rescue failed PK grafts.
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P173
A RETROSPECTIVE DATA REVIEW CONFIRMS THAT TOPICAL PRESERVATIVE-FREE HYDROCORTISONE IMPROVES INFLAMMATION IN DRY EYE DISEASE
Leon Markovic
Cornea
Leon

MARKOVIC
Croatia
Inflammation is among the most important mechanisms in the pathogenesis of dry eye disease (DED), triggering the vicious circle of the disease. Reducing inflammation is an important target in dry eye disease treatment. Hydrocortisone is a low-potency corticosteroid with a low ocular penetration potential. The aim was to document the effect of topical preservative-free hydrocortisone 0.335% (PFH, Softacort®, Laboratoires Théa, France) on DED.
Retrospective data review of patients with mild to moderate DED, treated with PFH for 15 days.
Clinical evaluations at Days 0 and 15 included the assessment of the central precorneal tear film thickness (CPTFT), fluorescein tear breakup time, Schirmer test, corneal grading staining (Oxford schema), ocular surface disease index (OSDI) spatial distribution of the precorneal tear film thickness, intraocular pressure (IOP) and local tolerance.
Data from 13 women and 2 men were collected. Mean age±SD was 51±5 years for women and 53±4 years for men. Clinical signs and symptoms significantly (all p<0.05) improved after 15 days of treatment. A significant positive correlation between the percentage of change in left eye CPTFT and that in the contralateral eye CPTFT was observed (p=0.003) as well as for both eyes and the left eye FTBUT (p=0.03). For the percentage of change in OSDI, the only significant correlation was with the percentage of change in right eye and FTBUT (p=0.03). IOP remained unchanged. No adverse events were recorded.
This retrospective data review confirms that topical PFH twice daily for 2 weeks significantly improves clinical signs and symptoms in patients with mild to moderate DED with no safety issues.
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P174
BROWN-MCLEAN SYNDROME IN AN APHAKIC PATIENT AFTER SPONTANEOUS ANTERIOR EMPTY CAPSULAR BAG DISLOCATION
Maria Martinez Hergueta
Cornea
Maria

Martinez Hergueta
Spain
Out-of-the-bag dislocations are rare and usually occurs in the late postoperative period. The major factors predisposing are still uncertain, but most cases are due to surgical complications or pseudoexfoliation. The aim of this study is to describe the diagnosis and treatment of a spontaneous empty capsular bag dislocation to the anterior chamber with no prior history of presumed traumatic damage and the evolution years later in a Brown-Mclean syndrome.
Department of Ophthalmology. Elda's General University Hospital, (Alicante), Spain
A 66-year-old high myopic woman arrived at our emergency service complaining about a white spot in her right eye. Her medical history was as follows, she reported deep amblyopia on her right eye and she underwent uncomplicated cataract extraction in both eyes 25 years before. On examination, her best corrected visual acuity (BCVA) was hand movements on her right eye and 20/40 on her left eye. The slit-lamp examination revealed an anterior dislocation of the empty capsular bag with cortical debris. On the fundus examination we just could view the posterior pole that showed an advanced myopic degeneration.
The patient was given topical cycloplegic every 8 hours and 1% prednisolone drops every 2 hours. The ultrasonography B showed the intraocular lens dislocated into the vitreous cavity. We performed an intraocular 23-gauge vitrectomy surgery to extract the capsular bag and the intraocular lens and we opted to leave the patient aphakic. Five years after the surgery the patient arrived at our clinic complaining about pain in her right eye and she presented a clear central cornea with peripheral corneal edema. She was diagnosed with Brown-Mclean syndrome.
Few cases of spontaneous anterior dislocation of the empty capsular bag have been reported and the main predisposing factors proposed are ocular trauma in highly myopic eyes or severe rubbing. An advance myopic degeneration and previous poor vision delayed the diagnosis of out-of-the-bag dislocation. Brown-Mclean syndrome is a rare condition with peripheral corneal edema observed in aphakic patients. This case highlights the importance of an early diagnosis to perform an early intervention and the follow-up of this kind of patients for the management of corneal decompensation.
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P175
EIGHT YEAR RESULTS OF ACCELERATED EPIOFF CORNEAL CROSS-LINKING IN PATIENTS WITH PROGRESSIVE KERATOCONUS
Miguel Rechichi
Cornea
Centro Polispecialistico

Mediterraneo
Italy
Evaluate the long-term functional results based on keratometric measurements, spherical and cylinder equivalent in patients with progressive keratoconus treated with 15 mW/cm2 pulsed-light epithelium-off accelerated CXL
Retrospective study in which 300 eyes from 200 patients affected by keratoconus with miminum thickness of 400 micron was treated with accelerated crosslinking between 2012 and 2020 in single center ( Eye Center Dr Rechichi) .
All patients were evaluated preoperatively, and a follow-up was performed at 1, 3, and 6 months and every year from 1 to 10 years after accelerated CXL. After epithelium removal and 10 minutes stromal soaking with riboflavin 0.1% hydroxypropyl methylcellulose solution, all eyes had 15 mW/cm2 pulsed- light epithelium-off accelerated CXL for 6 minutes of ultraviolet-A (UVA) irradiation (1 Second on/1 off), maintaining a total UVA exposure of 12 minutes at a fluence of 5.4 J/cm2. Follow-up examination included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, Scheimpflug tomography, and spectral- domain optical coherence tomography (SD-OCT).
We observed significant improving in all keratometric values during the follow-up. Kmax decrease become statistically significant at 1 year after CXL and remained statistically significant thereafter up to 8 years. Mean spherical equivalent and mean cylinder both improved during the follow-up. Also uncorrected and corrected visual acuity increased remaining statistically significant, at the 8 years after CXL. We did not observe any case of severe complication.
Our results show that 15 mW/cm2 pulsed-light epithelium-off accelerated CXL was effective and safe, stabilizing keratoconus progression through 8 years of follow-up.
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P176
COMBINED NEUROTROPHIC AND EXPOSURE KERATOPATHIES: “SECOND WAVE” OF NASOPHARYNGEAL CARCINOMA OPHTHALMIC FEATURES
Imad Messafi
Cornea
Imad

MESSAFI
Morocco
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood. The two most common. histologic variants are embryonal and alveolar subtypes. Head and neck localisations include the nasopharynx, which can be responsible of multiple ophthalmic symptoms following the concerned structures. Ocular surface features are usually due to exposure. We report a rare case combining a neurotrophic and exposure keratopathies following treatement of nasopharyngeal RMS.
Ophthalmology departement, Mohammed VI univeristy hospital, Oujda, Morocco
A 9 years old girl, treated by chemotherapy for nasopharyngeal RMS. She presented neurotrophic and exposure keratitis secondary to combined compression of trigeminal and facial nerves.
Patient admitted for left ptosis and decreased vision. She had dental extraction, abscess and otalgia, treated as otitis without improvement. Ophthalmological exam was normal in right eye , OS: VA at 0.5, proptosis, ophthalmoplegia with semi-mydriasis and normal fundus: Gradenigo and orbital apex syndromes with facial paralysis. Imaging: nasopharyngeal tumor extended to infratemporal fossa, mastoid cells , carotid artery, temporal lobe, optical channel, cavernous sinus and trigiminal nerve. Biopsy: embryonnal RMS. After chemotherapy, she presented lagophthalmos, corneal ulcertaion, abolition of corneal sensitivity and infectious keratitis. Evolution was favourable under preservative free lubricant agents, fortified eye drops and eye occlusion.
In this report, we describe a case of neurotrophic keratopathy associated with nasopharyngeal RMS. Extension to cavernous sinus and trigeminal nerve seems to be causative of epithelial defect , meanwhile facial paralysis aggravated the clinical presentation by exposing cornea. As most cases of ocular impact of nasopharngeal carcinoma, our patient presented initially neuro-ophthalmic manifestations . Due to chemotherapy and regression of third cranial nerve compression , the ' protective ' effect of ptosis disappeared , enabling combination of the previous cited corneal complications.
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P177
GLOBE RUPTURE REVEALING OSTEOGENISIS IMPERFECTA
Imad Messafi
Cornea
Imad

MESSAFI
Morocco
Osteogenesis imperfecta (OI) is a connective tissue disorder resulting from abnormal collagen type1 . It is characterized by different clinical manifestations including skeleton, ears, eyes, teeth, skin and joints. Ocular features of OI are various , from which we site megalocornea, keratoconus , keratoglobus, blue sclera, spontaneous globe rupture, primary optic atrophy, papilledema, congenital glaucoma, cataracts, dislocated lens and choroidal sclerosis .Treatment is essentially based on prevention of traumas, physical aids and surgery
ophtalmology departement, Mohammed VI university hospital, Oujda, morocco
we report a case of spontaneous globe rupture revealing OI in young woman
A 31-old women was admitted for painful left eye occurring spontaneously. Her medical history showed congenital deafness. Examination : light perception, circular corneo-limbal wound from 5h to 12h with choroid protrusion, a keratoglobus in the right eye with central opacity, which made corneal topography difficult .We noticed that patient had joints laxity, scoliosis and bone deformities related to multiple traumas, confirmed by radiographies. The mother confirmed that 'blue sclera 'presence at birth. We concluded to a brittle cornea syndrome overlapping with OI. Visual acuity was still limited to light perception and she was addressed to ENT and orthopaedics specialists.
We report a unique case of osteogenisis imperfecta overlapping with brittle cornea syndrome, causing a spontaneous globe rupture occurring in a fragility zone of a thinned cornea. The diagnosis was essentially made by discovering keratoglobus, then linking it to the other systemic manifestations. Our case enlightens the importance of the early recognition of OI, in order to prevent ocular and extra-ocular complications and provide a better quality of life to these patients.
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P178
AN ILLUSTRATED RARE CASE OF ANTERIOR SEGMENT MANIFESTATIONS OF WEGNER GRANULOMATOSIS
Imad Messafi
Cornea
Imad

MESSAFI
Morocco
Granulomatosis with polyangiitis (GPA), previously known as Wegener Granulomatosis, is an autoimmune disorder characterized by granulomatous necrotizing vasculitis that typically affects small and/or medium sized blood vessels in the orbit, respiratory tract (sinuses, nose, throat, lungs), and kidneys. Ocular manifestations can inculde every structure of the eye ranging from the orbit and eyelids, to the retina and optic nerve.
Ophthalmology department, Mohammed VI university hospital, Oujda, Morocco
A 63 Y.O woman presenting a severe form of anterior ocular features related to GPA
we report the case of a 63 Y.O woman , with medical history of treated pulmobnary tuberculosis , addmitted for headeaches , febrile dry cough evolving since 6 months with wieght loss. she presented a decreased VA with sensation of foreign body in both eyes. Ophthalmological examination showed a VA of HM in RE and 0.2 in LE , with in both eyes an extremly thinned sclera mimicking scleromalacia, multiples corneal opacities with neovascularisation. she also presented multiples lung micronodules , a chronic sinustis. P-ANCA was positif with tuberculosis screening negatif. Biospy showed a granuloma without necrosis. She recevied local and systemic antiinflammatory treatement with mild improvement and discussion of using immunosuppressant agents.
our case do illustrates a rare entity of a systemic disease manifestations , that may lead to be more inclusive of this features in the diagnosis criterias of the disease.
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P179
CORNEAL INVOLVEMENT IN PAEDIATRIC GRAVES OPHTHALMOPATHY
Imad Messafi
Cornea
Imad

MESSAFI
Morocco
Graves disease is an autoimmune disorder characterized by the presence of pathogenic antibodies (thyroid receptor antibodies or 'TRAb', stimulating the thyroid gland directly through the TSH-receptor (TSHR). The diagnosis of GD is based on clinical signs of hyperthyroidism, thyroid function tests, and the presence of thyroidstimulation autoantibodies .The principal ocular symptoms are eye irritation , foriegn body sensation ,excessive tearing that is often made worse discomfort or pain, blurred vision, binocular diplopia. Even if vision threathening manifestations seems to be rare among this population (optic nerve alteration, strabismus), attention should be given to cornea leading to vision loss.
Ophthalmology department, Mohammed VI university hospital, Oujda, Morocco
we report the case of a paediatric patient presenting reccurent corneal erosions due to Graves disease.
A girl of 6 years old , the first child of two , born from an consanguineous marriage, was admitted initially in the paediatric emergencies for a bilateral exophtalmos associated with a cervical mass, irritability and nervousness associated with liquid diarrehea , night sweats and palpitations. The diagnosis of Graves disease was confirmed by anti-bodies dosing and she was ttreated 40 mg of propanolol and 15 mg of carbimazol per day , with a decreasing heart rate to 120 bpm and regression of the general symptomatology.Two weeks later, she was admitted complaining of red painful eyes with blurred vision. Examination revealed a bilateral exophtalmos with retraction of the superior and inferior eyelids , blepharospasm , a connjunctival injection eye with presence of epithelial erosions with a break-up time inferior to 5 seconds. Motility and fundus examination were normal. The evolution was favourable under medical treatement consistent of artificial tear drops and vitamin A ointement.
Recent series are giving intrest to the corneal complications. 11 patients were found to have corneal complications by Chan and al .Hopefully, the manifestations consisted only of mild punctate epithelial erosions. These constatations are explained by the high frequency of lid retraction and lagophtalmos. It can be easily managed with lubricating eye drops and euthyroidism. Treatment should mostly be kept even if the graves disease is inactif , to prevent exposure keratopathy .To conclude , ocular manifestations in the Graves disease can be common in paediatric population. Even if they are less severe than in adults, our attention should be attracted through this case to the issue of eye dryness and surface alterations, that can only requiere eye drops ,and which can have an evolutive potential , that may lead to vision loss. a pedaetrician and ophthalmologist cooperation is crucial.
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P180
OCULAR SURFACE FEATURES OF REACTIVE ARTHIRITIS
Imad Messafi
Cornea
Imad

MESSAFI
Morocco
Reactive arthritis, formerly known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. By the time the patient presents with symptoms, often the'trigger' infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.The manifestations of reactive arthritis include the following triad of symptoms: an inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. ocular manifestations range from the usual bilateral conjonctivitis to rare keratitis and uveitis.
Ophthalmology department, Mohammed VI university hospital, Oujda, Morocco
we report the case of a 30 Y.O presenting a reactive arthirtis withe positive HLA-B27 and two episodes of ocular manifestations : bilateral conjunctivitis followed by keratitis
a 30 Y.O man with a history of multiple sexual intercourses was admitted to emergency for a bilatarel red eyes with mild pain. He presented multiple invalidant joints athrtitis intresting knees, hands and feet. the symptoms started weeks after he presented' pain while peeing'. a bilateral conjunctivitis was diagnosed treated by local nsaids and antiobiotiics , and he was reffered to internal medicine, where the screening showed a positive uretral prelevement for C.trachomatis with positive HLA b27. he presented a mild improvement of joints and ocular symptoms after receiving NSAIDs. A month after he presented a second episode of ocular pain with blurry vision with VA at 0.3 , corneal ulceration , for which he received anti-viral treatement followed by corticosteroids with excellent improvement , then reffered to internal medicine
our case illustrates a rare form of ocular manifestations of Reiter disease : Keratitis. Since this form is rare, we preffered to use a anti-viral cover before starting a anti-inflammaroty treatement for our patient.
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P181
REFRACTIVE AND VISUAL OUTCOMES AFTER KERRARING VS FERRARA
INTRASTROMAL CORNEAL RING SEGMENT IMPLANTATION FOR KERATOCONUS: A
COMPARATIVE STUDY
Ana Filipa Moleiro
Cornea
Ana Filipa

Moleiro
Portugal
To evaluate the refractive, topographic, optical, visual acuity, and quality outcomes of two types of intrastromal corneal ring segments (ICRS) in the treatment of keratoconus.
This study took place in the Department of Ophthalmology of Centro Hospitalar e Universitário de São João, a tertiary center from Portugal.
Restrospective study of eyes implanted with Ferrara ICRS and Keraring ICRS. Pre- and post-operative examinations, including best corrected visual acuity (BCVA), topography, and ocular wavefront analysis were performed. Statistical significance was considered when p<0.05.
Ferrara ICRS were implanted in 30 eyes, while Keraring ICRS were implanted in 18 eyes. Keratoconus grade was similar in both groups (p>0.05).
BCVA (Snellen scale) improved significantly from 0.34±0.16 to 0.63 ± 0.17 in the Ferrara group (p<0.001) and from 0.39 ± 0,19 to 0.63±0.14 in Keraring group (p<0.001). The postoperative increase in visual acuity was not statistically different between the two groups (p>0.05).
Keratometry evaluation revealed a significant decrease of 1.8±1.7D and 2.0±1.5D in Ferrara and Keraring groups respectively (p<0.001) with no statistical differences between the groups (p>0.05).
Considering wavefront analysis, both groups are comparable regarding high order aberrations.
Intra-stromal corneal ring segments are an effective treatment for visual improvement in keratoconus. Both ICRS types provided comparable refractive, topographic, and optical quality outcomes.
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P182
CASE REPORT : SEVERE BACTERIAL KERATITIS IN A RIGID CONTACT LENS WEARER
Zineb Morchid
Cornea
Zineb

morchid
Morocco
Bacterial keratitis on contact lenses is a serious pathology that can rapidly jeopardize the visual functional prognosis but is avoidable, hence the interest of prevention based on awareness.
Ohtalmology departement, August 20th, 1954 Hopital Ibn Rochd University, Centre Faculty of Medicine and Pharmacy Casablanca Hassan II University, Morocco
We report the clinical case of a young patient of 21 years old, having as antecedent a strong myopia and wearing contact lenses for 3 years. He consulted for painful red eye with visual acuity decrease, and the ophthalmologic examination had objectified a serious corneal abscess.
The patient was 21 years old, had a history of high myopia and had been wearing contact lenses for 3 years. He presented to the emergency room with a painful red left eye with a decrease in visual acuity. The ophthalmological examination showed that the visual acuity of the left eye was limited to hand movements, the examination of the anterior segment showed a ground-glass corneal aspect: subtotal central ulcer with dirty background, necrotic stroma, reactive hypopyon of the anterior chamber. A local broad-spectrum antibiotic treatment was started while waiting for the results of bacteriological, parasitological and myocological samples. The bacteriological sample revealed the presence of Pseudomonas aeruginosa.
Patient education on lens handling is part of the responsibility of the ophthalmologist and the lens prescriber.
A consultation with the ophthalmologist is necessary at the onset of simple eye redness, pain, photophobia, or decreased visual acuity.
It is important to insist on the respect of basic hygiene rules for all contact lens wearers:
- Use of an appropriate cleaning solution.
- Avoid bathing with your lenses
- Do not rinse your lenses with tap water or mineral water
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P183
A CASE OF ACANTHAMOEBA KERATITIS
Ioanna Gardeli
Cornea
Konstantina

Mouriki
Greece
The purpose of this paper is the presentation of the clinical course and the management of Acanthamoeba keatitis in a contact lens wearer.
This case is about a 25-year-old female patient who presented to the outpatient clinic complaining of eye pain and blurry vision in her left eye. The patient referred that she was using topical corticosteroid before visiting our clinic. The slit-lamp examination revealed radial keratoneuritis without anterior segment reaction.
The superficial corneal swab was used for cultures and Polymerase Chain Reaction (PCR). PCR was found to be positive for Acanthamoeba and cultures of Acanthamoeba were grown.
In this case we used col Desomedine and Polyhexamethylene biguanide (PHMB) 0.02%. The clinical course of the patient was good and the Acanthamoeba keratitis was cured without any long-term complications.
Radial keratoneuritis is a presenting sign in Acanthamoeba keratitis. Prompt diagnosis and treatment of Acanthamoeba keratitis may lead to a good visual outcome.
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P184
A CASE OF HERPETIC KERATITIS IN A PATIENT WITH PENETRATING KERATOPLASTY
Konstantina Mouriki
Cornea
Konstantina

Mouriki
Greece
The purpose of this paper is the presentation of the clinical course and the management of herpetic keratitis in a patient with penetrating keratoplasty.
This case is about a 31-year-old female patient with diabetes mellitus type I who presented to the outpatient clinic complaining of eye pain and blurry vision in her right eye. The slit-lamp examination revealed an epithelial defect without anterior segment reaction. Corneal sensation in her right eye was reduced.
The superficial corneal swab was used for Polymerase Chain Reaction (PCR). PCR was found to be positive for HSV-1.
In this case we used tb Valacyclovir, col Ofloxacin and oint Ganciclovir. The clinical course of the patient was good.
Prompt diagnosis and treatment of herpetic keratitis in a petient with penetrating keratoplasty may lead to the survival of the graft and a good visual outcome.
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P185
WOOD AND EYELASHES IN THE CORNEA!
Basma Mrini
Cornea
Basma

mrini
Morocco
Presenting an atypical post traumatic case with the presence in the cornea of wood and eyelashes.
Ophtalmology A department, hospital of speciality of Rabat
We report a case of a 12-year-old child, referred to the ophthalmologic emergency room for neglected trauma to the left eye following a fall.
Examination of the left eye showed a corrected visual acuity of 20/50. At inspection, the presence of a peripheral corneal foreign body was noted around 10 o'clock. Slit-lamp examination revealed a piece of wood embedded in the limb associated with two well-buried eyelashes in the corneal stroma surrounded by peri-lesional edema. Seidel test was negative and the anterior chamber was of good depth with a little Tyndall effect. Right eye examination was unremarkable.
Prevention of eye injuries in children is a health priority.
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P186
AUTOLOGOUS PLATELET‐RICH PLASMA DROPS FOR THE TREATMENT OF REFRACTORY MODERATE-TO-SEVERE EVAPORATIVE DRY EYE DISEASE FROM MEIBOMIAN GLAND DYSFUNCTION
Fahmeeda Murtaza
Cornea
Fahmeeda

Murtaza
Canada

To evaluate the effects of autologous platelet‐rich plasma (PRP) drops in patients with moderate-to-severe evaporative dry eye (EDE) from meibomian gland dysfunction (MGD).

This is a retrospective, consecutive case series of 20 eyes of 10 patients with moderate-to-severe refractory EDE from MGD treated with PRP at a single outpatient clinic in Ontario, Canada from November 2020 to April 2021.
Approximately 11ml of PRP drops were prepared from 22ml of whole blood using a two-step centrifugation method. Patients were instructed to instill the drops six times daily for 4 weeks. The Canadian Dry Eye Assessment (CDEA) questionnaire score, patient subjective assessment (PSA) score, first and average non-invasive keratograph tear break-up times (NIKBUT), tear meniscus height (TMH), bulbar redness (BR), and meibograph grade (MG) were measured before and after the 4-week treatment course.
Significant improvements in dry eye symptoms and functional dry eye outcomes were observed. Dry eye symptoms decreased from 19.78 ± 9.62 to 12.08 ± 7.40 (CDEA, p<0.001) and from 7.65 ± 1.74 to 4.77 ± 2.03 (PSA, p<0.001). First and average NIKBUTs increased from 5.30 ± 2.79s to 9.15 ± 5.54s and from 4.43 ± 4.46s to 11.24 ± 5.34s, respectively (p=0.001). TMH increased from 0.26 ± 0.19mm to 0.34 ± 0.18mm (p=0.005). BR decreased from 1.38 ± 0.49 to 1.02 ± 0.37 (p=0.008). Five eyes experienced a one-grade improvement in MG scores (p=0.096), and none of the eyes experienced worsening in MG with treatment. No temporary or permanent adverse effects were noted.
Four weeks of PRP therapy resulted in significant functional improvements in tear film quality and quantity, conjunctival injection, and dry eye symptoms. Structural improvements in meibomian glands were also observed in some eyes. Overall, PRP is an effective treatment option for patients with EDE from MGD who have failed to respond to conventional treatments.
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P187
EPIDEMIOLOGICAL, CLINICAL AND THERAPEUTIC PROFILE OF VERNAL KERATOCONJUNCTIVITIS.
Omar Nabih
Cornea
Omar

NABIH
Morocco
The aim of our work is to establish the epidemiological, clinical as well as the therapeutic profile in our African context, and to compare our results with those of the literature.
Vernal keratoconjunctivitis (KCV) is an allergic disease of the ocular surface, mainly affecting young children. It is held responsible for episodes of corneal-conjunctival inflammation.There are various epidemiological-clinical presentations that differs from one geographic region to another.
We conducted a retrospective study from January 2019 to October 2021.34 patients were enrolled. The diagnosis of KCV was based on a routine eye examination. Epidemiological, clinical and therapeutic informations were gathered from followup files and registers. Were excluded: patients with incomplete consultation files or insufficient information, or not found.
The average age is 9 years with extremes from 2 to 20 years. 77.1% of patients were under 12 years old at the time of diagnosis. A male predominance was observed : 68.6%, with a sex ratio (M / F) of 2.1. 40% of cases had other associated allergic disorders. Complaints were dominated by itching (pruritus ) (68.5%), redness (57.1%) and photophobia (48.6%). hyperemia and mucous discharge dominated the clinical signs 83% and 51.4% respectively. The tarsal form is observed in 51.4% of children, followed by the mixed form in 28.5%.The severity was classified from mild to moderate in 91.5% (grade I and II of the classification of M. Sachetti et al).
Three cases of cornea affections : superficial punctate keratitis in two patients and a vernal plaque in the third. Anti-granulants have been prescribed for all of our patients. Antihistamines were prescribed in combination with anti-granulants in 60% of patients Corticosteroids were used in 31.4% of patients, 22.9% of which were moderate
The use of molecules with low ocular absorption such as fluorometholone has been found. A corticodependency case received 2% local cyclosporine. A case of corneal plaque required surgical debridement of the plaque.
Vernal keratoconjunctivitis is a well-defined pathology that is often easily diagnosed.The problem of its management is due to its prolonged evolution.
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P188
THE BECOMING OF OCULAR SURFACE AFTER TRANSFIXING KERATOPLASTY: ABOUT 36 EYES.
Omar Nabih
Cornea
Omar

NABIH
Morocco
The transfixing keratoplasty (KPT) often represents a last resort for the permanent losses of transparency and corneal architecture.The damaging of the graft is often secondary to an ocular surface abnormality.
The purpose of our study is to: Determine the profile of epithelial abnormalities in the postoperative period of KPT , as well as the donor and the host variables that influence the state of the graft's epithelium.
Pediatric ophtalmology department, Hopital 20 Août 1953 Casablanca Morocco
We conducted a retrospective case study from December 2019 to March 2021 following the clinical evolution of 36 eyes after (KPT). We monitored the corneal epithelium for 6 months after surgery, using biomicroscopy, and fluorescein staining.The donor data analyzed were: age, sex, cause of death, time between death and preservation (DPT), time between collection and use of the graft in the recipient (TPU), total time (TT), state of graft epithelium and stroma.The host's data analyzed were: age, sex, indication of KPT, ocular surface condition, ocular comorbidity, local postoperative treatment.
The average age of the hosts was 43.5 ± 22.95.The average age of donors is between 50 to 75 years old. The corneal abnormalities observed in order of frequency are: superficial punctate keratitis (KPS), corneal ulcers<1/2 graft, corneal abscess, total corneal ulcer, in 86%, 36%, 8%, 4% respectively. These abnormalities decreased over time, and in some cases persisted after the 6th month.The age and sex of the donor significantly impacted the epithelial surface (p = 0.05 and 0.005 respectively), TPD, TPU and TT also had a significant influence on the corneal epithelium (p = 0.001, p = 0.05, p = 0.03 respectively).The donor's age and sex significantly affected the epithelial surface at D1 and for 2 weeks of KPT (p = 0.05, 0.04 and 0.005, 0.004 respectively).The cause of death affected the surface area at 2 weeks of the KPT (p = 0.05). TPD, TPU and TT also significantly impacted the corneal epithelium on D1 postoperative (p = 0.001, p = 0.05, p = 0.03 respectively). Without influence on the epithelium after this time.These abnormalities declined over time, and in some cases persisted after the 6th month. The majority of these epitheliopathies occurred in recipients over 45 years of age (76%).
Most of the risk factors for a defective epithelium cannot be controlled by the surgeon, however their prior knowledge helps in his treatment and this avoiding transplant rejection.The lack of graft's epithelium integrity leads to a delay in visual rehabilitation, and therefore exposes the risk of serious infection, especially fungal one.
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P189
SEMI-AUTOMATED METHOD FOR ANTERIOR SEGMENT DISEASES ASSESSMENT IN NEWBORNS WITH THE AID OF AS-OCT
Amparo Ortiz-Seller
Cornea
Amparo

Ortiz-Seller
Spain
To propose an exploration protocol and to develop a method that can provide objective analysis of corneal opacity in newborns with the aid of AS-OCT.
Congenital clouding can result from various metabolic, infectious, developmental, and idiopathic causes. Comprehensive examination should be undertaken in infants presenting with any of these signs in order to achieve early diagnosis and appropriate therapy, as they can significantly improve the visual prognosis.

This is a retrospective study conducted at the Department of Pediatric Ophthalmology and Strabismus of the University and Polytechnic Hospital La Fe in Valencia, Spain. Information on the clinical characteristics of newborns with corneal opacity were collected. Multiple pictures of anterior segment were acquired with AS-OCT CASIA SS-1000 (Tomey, Nagoya, Japan) as a way to obtain many enough quality images as possible. The AS-OCT images of 16 eyes were analyzed by two masked Pediatric Ophthalmologists and parameters of pachymetry, iridocorneal angle status and mean gray value (MGV) were obtained. MGV was acquired with our proposed method with the aid of ImageJ software.
All patients underwent bilateral AS examination with AS-OCT. Four patients were female and four were male. The average of age was 12.5 days. Four patients were only 1 day old. Eight eyes were diagnosed of bilateral primary congenital glaucoma, one of secondary glaucoma after cataract surgery, four of bilateral type 1 Peters' anomaly associated with glaucoma, and one of unilateral Descemet membrane tear secondary to forceps delivery. Inter and intraobserver reproducibility for the two examiners was very good and there was a non-significant difference in intraobserver reliability between the two observers by using the proposed method for MGV calculation. Moreover, MGV showed good correlation with clinical corneal opacity score, and enables a precise measurement of corneal opacity in a shorter period of tim, thus helping to determine the need of additional treatments such as keratoplasty.
Prompt diagnosis is mandatory in cases of congenital corneal opacity but remains challenging on some occasions, and limited by the child's cooperation. AS-OCT remains a rapid, noncontact and noninvasive technique, which can provide high resolution and quantitative documentation of ocular changes in newborns. The application of imaging processing techniques such as our proposed method for MGV calculation, could help in the initial evaluation and precise monitorizacion of anterior segment diseases in early childhood.

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P190
OCULAR SURFACE CHANGES IN PATIENTS WITH THYROID OPHTHALMOPATHY
Ömer Özer
Cornea
Ömer

ÖZER
Turkey
To determine the severity of the disease in patients with a diagnosis of thyroid ophthalmopathy and to make a quantitative and qualitative classification of observed ocular surface disorders.
This study was conducted at Department of Ophthalmology, Faculty of Medicine, Mersin University between March 2020 and March 2021.
176 eyes of 48 patients and 40 healthy adult control group were included in this study. OSDI questionnaire, NOSPECS stage, Clinical Activity Scores, Schirmer I test, EUGOGO disease severity scale, ocular surface staining scores, tear break-up time, Hertel exophthalmometer measurements, and blink count were recorded.
There were 15 (31.3%) male, 33 (68.8%) female in the patient group, 14 (35%) male and 26 (65%) female in the control group. The mean age of the patient group was 47.6 years, the mean age of the control group was 45.3 years. Both groups were similar in terms of these characteristics. OSDI scores was 63.5 in the patient group and 3 in the control group. The tear breakout time was 9.5 seconds in the patient group and 20 seconds in the control group. The Schirmer I test was 15 millimeters in the patient group and 27 millimeters in the control group. (p< 0.001, for all data)
Of the patients, 23 (47.9%) had mild disease, 16 (33.3%) had moderate-to-severe disease, and nine (18.8%) had sight-threatening disease. As the disease severity increased, the mean age of the patients increased, the OSDI scores decreased, and the tear breakout times decreased.

It should be kept in mind that ocular surface involvement may occur at any stage of the disease. Questionnaires, ocular surface staining and Schirmer tests are needed to evaluate the ocular surface.

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P191
COULD ACUTE CORNEAL ENDOTHELIAL GRAFT REJECTION BE A POST-COVID CONDITION?: A CASE REPORT
Peter Pego
Cornea
Peter

Pego
Portugal
To report a case of acute corneal endothelial graft rejection 5 weeks after the diagnosis of coronavirus disease 2019 (COVID-19)
Ophthalmology Department
Case report
A 30-year-old Caucasian man with a history of bilateral keratoconus and no other health problems developed acute corneal endothelial graft rejection 11 months after uncomplicated penetrating keratoplasty of the left eye. Five weeks earlier, he was diagnosed with COVID-19 but had no symptoms at the time. He was complying to topical corticosteroids therapy, as prescribed, and denies any other type of complication that could explain the rejection of the corneal graft. Six weeks after starting aggressive therapy with topical and oral corticosteroids and hypertonic drops of sodium chloride, there was reversal of endothelial rejection with improvement in corneal transparency, visual acuity and number of endothelial cells.
There are reports of acute corneal graft rejection, either in patients in the acute phase of COVID-19 or after vaccination against COVID-19. Post-COVID conditions is a term used for a wide range of health consequences that are present four or more weeks after infection with COVID-19 and can occur in patients who have had varying degrees of illness including those who had mild or asymptomatic infections. Multiorgan system effects of COVID-19 have been documented in most, if not all, body systems including cardiovascular, pulmonary, renal, dermatology, neurology, and ophthalmology. Some studies reveal that post-COVID may be detectable in the eyes of patients, in the form of nerve damage and increase in dendritic cells density that can be seen in the cornea. These migration and accumulation of dendritic cells in the central cornea is consistent with an innate immune and inflammatory process that could result in acute corneal graft rejection. Clinicians and researchers are still in the early stages of understanding post-COVID conditions and it can be difficult to distinguish symptoms caused by post-COVID conditions from symptoms that occur for other reasons. As far as we know, this is the first report of a case of acute corneal graft rejection that could be the presentation of a post-COVID condition.
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P193
PROGRESSIVE IMMUNOLOGICAL OCULAR INFLAMMATION POST COVID-19 RELATED INFECTION: FIRST REPORTED CASE
Mrinal Rana
Cornea
Mrinal

Rana
United Kingdom
To present a challenging case of nodular episcleritis with crystalline keratopathy which progressed to develop Corneal melt (Peripheral Ulcerative Keratitis; PUK) in a patient after contracting COVID-19 Infection.
Corneal and external disease services, Department of Ophthalmology, University Hospital Coventry and Warwickshire, Coventry, United Kingdom
Retrospective Case report
A 55-year-old female presented to eye casualty with sectoral congestion of her left eye with mild discomfort. She also complained of photophobia, and normal vision. Detailed past medical history did not give any medical history nor did she have any past ocular history to report. Her best corrected distance visual acuities were 0.0 LogMAR in both eyes. Ocular examination revealed a healthy looking right eye. The left eye had signs of nodular sectoral Episcleritis with crystalline keratopathy in the deeper stromal layers of the nasal peripheral cornea. No anterior chamber inflammation was seen, but her intraocular pressures were asymmetrically raised between both eyes (right – 16mm Hg and left – 25mmHg on Goldmann applanation tonometry [GAT]). She was treated with topical steroids and anti-glaucoma therapy, which initially controlled the Episcleritis signs, but then started to develop frequent recurrence as soon inspite on topical therapy. Her crystalline keratopathy would lead to stromal oedema and increase in haze during the recurrences. She was investigated multiple times for COVID via blood test and RT-PCR of the tear samples from both her eyes which came back to be negative. Immunological testing was found to be completely normal.

From the time of presentation in Feb 2021, over a period of 6 months the episcleritis progressed to scleritis and PUK with nasal corneal thinning and overlying epithelial defect. Infectious and vasculitic causes were excluded with help from the rheumatological team. Eventually she was then started on oral prednisolone (1mg/kg BW) and put on a very slow tapering course. This resulted in disease control and brought the patient into remission and recovery with stabilisation of disease. At the time of this abstract patient is on low dose Oral Prednisolone 5mg once a day with no recurrence, with an aim to stop steroids completely in 4 weeks over a further tapering course.
This is the first case to report a moderately severe ocular inflammatory process being triggered post COVID infection. Till date we have not been able to establish positive COVID antibodies or COVID from blood or tear samples. But it cannot be just a co-incidence that she started to develop ocular inflammation within 2 weeks of developing a confirmed COVID-19 Infection. We would like to highlight this case so that Ophthalmic community are aware of occurrence of ocular Inflammation as a side effect of COVID -19 infection and treat them accordingly.
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P194
UNILATERAL CORNEAL HYDROPS ASSOCIATED WITH VERNAL KERATOCONJUNCTIVITIS AS A REVEALING SIGN OF KERATOCONUS: ABOUT THREE CASES
Kamelia Rifai
Cornea
Kamelia

rifai
Morocco
To report cases of unilateral corneal hydrops associated with vernal conjunctivitis as a presenting sign of keratoconus.
Corneal hydrops corresponds to an aqueous infiltration of the cornea following a breach in the descemet membrane. It usually complicates keratoconus but it can occur on pellucid marginal degeneration, keratoglobus or other. The treatment of acute hydrops has improved significantly in recent years.
We report a series of 3 patients with acute hydrops with no known underlying etiology. Our patients were enrolled in the ophthalmology department A at the hospital of specialties in Rabat. All patients initially consulted for a sudden decrease in unilateral visual acuity. They underwent a complete ophthalmological examination including a measurement of far and near visual acuity with correction, a measurement of eye tone and a biomicroscopic examination of the anterior and posterior segment with the realization of an eye fundus, pachymetry, corneal topography, and an Optical coherence tomography of the anterior segment.
The average age of our patients is 19.5 years. These are 2 men and 1 woman. All of our patients are being monitored for allergic conjunctivitis. Patients were seen urgently for pain and photophobia with worsening loss of visual acuity. Visual acuity on the day of admission was less than 1/10 in all cases. Slit lamp examination found a perikeratic circle associated with edema and corneal thickening. After a bilateral and complete clinical examination, the diagnosis of hydrops complicating keratoconus was retained in all cases. All of our patients received initial medical treatment consisting of lubricants, cycloplegia and systemic anti-hypertensive drugs (oral acetazolamide). One patient received an intracameral injection of SF6 gas. Regression of irritative signs and edema was obtained in a few days in two patients with an improvement in visual acuity greater than 3/10, the third was placed on the waiting list to benefit from a transfixing keratoplasty.
Corneal hydrops is a rare complication of keratoconus, but it marks a turning point in the course of the disease. Hereditary and environmental factors may contribute to the etiology of keratoconus and corneal hydrops.
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P195
THE BEHAVIOR OF CHORD MU (Μ) AND CHORD ALPHA (Α) LENGTH IN FUCHS ENDOTHELIAL CORNEAL DYSTROPHY AFTER DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY (DMEK) SURGERY
Carlos Rocha-De-Lossada
Cornea
Carlos

Rocha-de-Lossada
Spain
To evaluate chord mu and alpha length in patients with Fuchs endothelial corneal dystrophy (FECD) and its changes following Descemet membrane endothelial keratoplasty (DMEK).
Hospital Clinic of Barcelona, Spain. Department of Cornea and Anterior Segment
In this retrospective study, all DMEK surgeries performed at the Hospital Clinic of Barcelona in patients suffering from FECD between March 2017 to March 2019 by the same surgeon with at least 12 months follow-up were included. All patients were pseudophakic. Data prior to surgery, and at 1, 3 and 12 months postoperative were collected. Patients with previous corneal surgery, iris defects different from YAG-iridotomy and intra-/post-operative complications were excluded. Scheimpflug Tomography was carried out in order to calculate chord mu and chord alpha lengths prior to surgery and at 3 and 12 months postoperative by the same Ophthalmologist. All scans was previously done by the same optometrist. Data was analyzed with SPSS statistics software (version 26.0 for Windows; SPSS Inc, Chicago, IL, USA). Accepting an alpha risk of 0.05 and beta risk of 0.2 in a two-sided test, 25 subjects are necessary to recognize as statistically significance a difference greater than or equal to 0.05. The standard deviation is assumed to be 0.15. It has been anticipated a drop-out rate of 10%.

This study included 27 eyes from 27 patients. Significant changes in chord mu were observed within the first three months (from 0.47 ± 0.32 to 0.29 ± 0.21 mm, p<0.01) and remained stable 12-months postoperative (0.30 ± 0.21 mm, p> 0.05). However, chord alpha remained stable throughout the 12-months post-surgery (from 0.53 ± 0.19 to 0.49 ± 0.14 mm, p> 0.05). In addition the distance from corneal apex to pupil center did not suffer any changes, from 0.35 ± 0.24 mm to 0.34 ± 0.20 mm (p=0.52) between preoperative and twelve-months postoperative after DMEK
Chord mu decreased in the first month after DMEK and remained stable with a minimal variation, especially between the third and twelfth month. Furthermore, chord alpha remained unchanged after surgery and during the entire follow-up. Here we describe the behavior of these variables after DMEK surgery. These findings may be necessary to consider in patients planning for MIOL implantation after combined with DMEK surgery.
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P196
BILATERAL DESTRUCTIVE MOOREN’S ULCER IN PREGNANCY AND MULTIDISCIPLINARY APPROACH TO MANAGEMENT: AN UNIQUE CASE REPORT
Puja Prativa Samantaray
Cornea
Puja
Prativa
Samantaray
United Kingdom
To present a challenging case of Mooren's ulcer in pregnancy, initially overlooked as inflamed pterygium and successfully managed with close liaison between ophthalmology, obstetrics and rheumatology teams.
Corneal and external disease services, Department of Ophthalmology, University Hospital Coventry and Warwickshire, Coventry, United Kingdom.
Retrospective Case report
A 39-year-old African woman presented at 36-week gestation with acute onset bilateral decrease in vision, red, painful eyes associated with photophobia and epiphora. Initially, her eye symptoms were attributed to bilateral inflamed pterygium with dellen, and she was advised topical lubricants, surface steroids which did not help. On a closer look, slitlamp examination showed peripheral corneal thinning nasally in both eyes which was confirmed on anterior segment OCT. There was no scleral involvement and no evidence of uveitis. Blood investigations were unremarkable apart from a slightly low haemoglobin, raised ESR, CRP with negative autoimmune and systemic infection screen. To aid in diagnosis a conjunctival biopsy was also done which showed chronic inflammation of the conjunctiva with negative direct immunofluorescence in both eyes. Screening for deposition of IgM, IgG, IgA, C3 and fibrinogen was also negative. HLA typing was positive for HLA-DQ2 and negative for HLA-DR17.
A diagnosis of peripheral ulcerative keratitis- Mooren's ulcer was established. Bilateral conjunctival resection with Amniotic membrane transplant was done. However, without systemic immunosuppression it was difficult to control her disease activity with topical steroids and local surgical management alone. Systemic methylprednisolone pulse dose followed by oral prednisolone was started under close supervision of the obstretics team and an early Caeserian section was done at 39-week gestation. Following this she was started on oral Mycophenolate under the guidance of rheumatologist. She achieved excellent visual recovery with resolution of active keratitis and stable peripheral thinning without corneal perforation.
Mooren's ulcer is an idiopathic painful peripheral ulcerative keratitis with devastating sequalae resulting in corneal perforation and sight loss.
Pregnancy poses a challenge to initiate cytotoxic therapy and effects of hormonal and immunological changes in pregnancy on disease activity can be difficult to manage.c
Mooren's ulcer can be successfully treated with good planning and multidisciplinary liaison between Ophthalmologists, Rheumatologists and Obstetricians.
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On-demand

P197
CONE APEX CENTERED PHOTOTHERAPEUTIC KERATECTOMY WITH ACCELERATED CORNEAL COLLAGEN CROSS-LINKING FOR PROGRESSIVE KERATOCONUS
Shraddha jayant Shah
Cornea
Shraddha
jayant
shah
India
To evaluate the visual, refractive and topographic outcomes of combined cone apex centered trans-epithelial phototherapeutic keratectomy (T-PTK) with accelerated corneal collagen cross-linking (CXL) in keratoconus (KCN)
Prospective interventional study
32 treatment- na&iuml;ve eyes of patients with progressive KCN underwent customized cone apex centered T-PTK with accelerated CXL. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, keratometry (K) values, epithelial thickness and corneal aberration profile were documented at baseline and at 1, 3, 6 and 12 months post-operatively
UCVA, BCVA and manifest refraction showed significant improvement at 12 months follow up (P<.001). Keratometric outcomes with flat and steep K were not significant although maximum keratometry (Kmax) showed significant improvement at the end of one year (P=0.03). Corneal aberration profile showed significant improvement in the total root mean square (RMS), RMS higher order aberration, spherical aberration and vertical coma by the end of one year (P=0.01).

Cone apex centered PTK with accelerated CXL using customized ablation for the treatment of keratoconus provides good visual, refractive and topographic outcomes.

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P198
EFFICACY OF NOVEL TIXEL TREATMENT IN REDUCING DRY EYE SIGNS AND SYMPTOMS, A
PROSPECTIVE MULTICENTRE CLINICAL TRIAL
Sunil Shah
Cornea
Sunil

Shah
United Kingdom
To determine the efficacy of a fractional skin rejuvenation system (Tixel) on alleviating dry eye signs and symptoms in a prospective, multicentre clinical trial.
Prospective, cross-sectional, multicentre, controlled clinical setting
The study was conducted at Birmingham, UK; Andorra and Cambodia. Participants with dry eye symptoms, OSDI score>13, NIBUT ≤ 10 seconds were recruited. Three Tixel treatments were conducted at 2-weeks intervals (40 peri-orbital non-ablative microthermal delivery of heat for 8 milliseconds and 400-micrometer protrusion (0.18 millijoules/point). Participants were followed up at the baseline, 2-weeks after 1st (visit 2), 2nd (visit 3) and 3rd treatment (visit 4), and 6 weeks after 3rd treatment (visit 5). Detailed dry eye assessments including OSDI questionnaires, non-invasive break-up time (NIBUT) and tear osmolarity were investigated.
A total of 120 participants were recruited, the average age was 57±13.8 years, among them 87 were females. By the time of reporting 109 participants completed visit 4 and 78 participants completed visit 5. Ocular dryness by OSDI score after visit 2, 3, 4, and 5 improved by 10.6.2±4.7, 14.4±6.0, 18.8±8.9, 20.6± 9.6 (P<0.001) respectively, which are higher than the minimal clinically important difference (MCID). NIBUT improved 2.2±0.9 in Birmingham centre, 2.4±1.1 in Cambodia, 6.1±2.9 in Andorra centre (P<0.05. Tear osmolarity for right and left eye reduced from 298.3±14.6 and 298.4±14.4 to 294.9±8.5 (P=0.090) and 295.6±8.7 (P=0.041) mOsm/L respectively.
Tixel treatments significantly reduce key clinical parameters of dry eye signs and symptoms when followed up to 3 months post-treatment.
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On-demand

P199
VISUAL, REFRACTIVE AND TOPOGRAPHIC RESULTS AFTER IMPLANTATION OF INTRASTROMAL CORNEAL RING SEGMENTS IN PATIENTS WITH NIPPLE PHENOTYPE OF KERATOCONUS
Álvaro Silva
Cornea
Álvaro

Silva
Portugal
Keratoconus is a common, idiopathic corneal disorder with a substantial impact on the vision-related quality of life. This study aims to evaluate the visual, refractive and topographic outcomes of intrastromal corneal ring segments (ICRS) implantation in patients with nipple phenotype of keratoconus.
Ophthalmology Department, Hospital de Braga, Braga, Portugal
This retrospective cohort study included 29 eyes from 29 patients with nipple phenotype of keratoconus submitted to implantation of ICRS using a manual technique at the Hospital de Braga - between July 2011 and December 2016 - with a minimum postoperative follow-up time of 6 months. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), subjective refraction, corneal topography and corneal pachymetry were evaluated preoperatively and at 6 months postoperatively.
At 6-months postoperatively, CDVA and UDVA were 0.26 ± 0.15 and 0.50 ± 0.20 logMAR, respectively, with a mean gain of 0.74 ± 0.21 (p<0.001) and 0.66 ± 0.20 logMAR (p<0.001). The safety index was 2.17 ± 2.21 and the efficacy index was 1.20 ± 1.44. 72.4% of the eyes revealed a gain of 1 or more Snellen lines of CDVA with 24.1% of the eyes showing a loss of 1 or more Snellen lines of CDVA. All refractive parameters - sphere (p<0.001), cylinder (p<0.001) and spherical equivalent (p<0.001) - revealed a significant postoperative improvement. Q-value (p<0.001), coma (p=0.003), anterior K1 (p<0.001), anterior K2 (p<0.001), anterior maximum K (p=0.002) and posterior K2 (p=0.006) improved significantly after ICRS implantation. No significant pachymetric changes were found from preoperative to postoperative evaluations (p=0.16). No vision threatening complications were noticed. No cases of endothelial perforation or epithelial extrusion of ICRS were observed.
ICRS implantation is an effective surgical procedure to improve visual, refractive and topographic parameters even in patients with nipple keratoconus. We found an excellent safety profile, with no intraoperative and postoperative complications in the first 6-months of follow-up.
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P200
GIANT SQUAMOUS CORNEAL NEOPLASIA MONITORIZED WITH SPECTRAL-DOMAIN OPTIC COHERENCE TOMOGRAPHY (SD-OCT)
Irene Simó-Giner
Cornea
Irene

Simó Giner
Spain
To describe a case of giant squamous corneal neoplasia monitorized with the aid of spectral-domain optic coherence tomography (SD-OCT).
A 95-year-old man presented with 5-months history of left eye (OS) pain. The anamnesis only revealed history of traumatic injury in OS with adequate vision recovery. Visual acuity in OS was amaurosis and slit-lamp examination demonstrated elevated nodular diffuse whitish mass completely covering the corneal surface, with neovascularization. High-resolution anterior segment module of SD-OCT showed hyperreflective corneal epithelium thickening, with maximum measurement of 385µ and no signs of deep corneal or intraocular invasion were observed. Clinical features strongly suggested giant squamous corneal neoplasia. Therefore, Interferon-&alpha;2b eyedrops 1MIU/mL 4/day were started with no identification of adverse effects.
A close follow-up with anterior segment color photographs and SD-OCT examinations was performed.
Complete recovery was achieved with no hyperreflectivity in corneal epithelium, 4 months later. Examination of anterior chamber was allowed, with subsequent white cataract detection. In this case, topical therapy treated successfully the entire ocular surface and avoided surgical intervention.. At 12-months follow-up, our patient remained clinically stable with no signs of squamous corneal neoplasia relapsing on SD-OCT.
Ocular surface squamous neoplasia encompasses a varied spectrum of disease involving abnormal growth of dysplastic squamous epithelial cells on the surface of the eye. High-resolution SD-OCT represents a valuable tool that can be employed as an in vivo diagnostic modality, as well as in the initial extent assessment and for delineating tumor recurrences following primary curative treatment.
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On-demand

P201
CORNEAL EPITHELIAL INGROWTH AFTER LASIK
Irene Simó-Giner
Cornea
Irene

Simó Giner
Spain
To describe a case of corneal epithelial ingrowth (EI) after laser assisted subepitelial keratomileusis (LASIK) monitored with corneal optical coherence tomography (OCT) and corneal topography.
A 46-year-old woman presented with ocular discomfort in her left eye (OS). She reported past history of corneal refractive surgery with LASIK in both eyes 6 years earlier. Best corrected visual acuity using Log MAR chart was 0.05 in the right eye (OD) and 0.1 in the OS. Refraction values were +0.25 (-1.25 x 76º) in OD, and +0.25 (-1.00 x 33º) in OS. Slit-lamp examination revealed an 8x1mm epithelial corneal irregularity in OS, compatible with post-LASIK EI grade 2. Fluorescein staining was negative and no additional anterior segment alterations were observed. Intraocular pressure and fundus examination were normal in both eyes.
Corneal topography, OCT and anterior pole photographs were performed in both eyes for further monitorization.
The diagnosis of post-LASIK EI was established. A conservative attitude was chosen and artificial tears were prescribed. At the following visits, no progression of the lesion was evidenced and BCVA remained stable. EI is defined by the presence of corneal epithelial cells at the flap interface after LASIK. It is infrequent in primary procedures, but the incidence increases when the flap is raised in reoperations. The etiology is still poorly understood, but poor flap adhesion or apposition may allow migration of surface epithelium into the interface. EI is usually a casual, non-progressive and asymptomatic finding, but could affect vision due to visual axis invasion or secondary irregular astigmatism. In cases of decreased vision or flap melting, mechanical cleaning of epithelial cells and achieving closure of the flap edge to prevent recurrent invasion of epithelium into the flap stromal interface space is indicated. However, the treatment itself constitutes a risk factor for recurrence, so it is not recommended to treat asymptomatic and stable EI. Close monitorization with the aid of corneal topography or OCT is essential for monitoring disease progression.
Post-LASIK EI is an uncommon complication, that remains asymptomatic in many cases. Observation with anterior segment imaging tools such as OCT, serves as a useful investigation in detecting subtle changes that are not readily evident on slit lamp examination.
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On-demand

P202
OXYGEN BOOSTED TRANSEPITHELIAL CORNEAL COLLAGEN CROSS-LINKING : ULTRASTRUCTURAL RESULTS
David Touboul
Cornea
David

TOUBOUL
France
Corneal collagen cross-linking (CXL) treatment is an oxygen-dependent reaction. A new technique of transepithelial CXL using specially designed oxygen delivery goggles has been proposed to provide a high oxygen environment into the cornea.

Bordeaux Hospital and University, national reference center for keratoconus, Bordeaux, France
Patients with progressive KC were involved and transepithelial, pulsed, accelerated CXL in an oxygen-rich atmosphere was performed (Oxygen boosted CXL from Avedro - USA). We registered postoperatively the OCT demarcation line depth using an anterior segment optical coherence tomography (AS-OCT) and a swept-source OCT-topography (SS-OCT) in between 3 and 6 months. Corneal innervation and keratocyte activation were subjectively evaluated with confocal microscopy. As well, endothelial cells count was assessed at each visit using a non-contact specular microscopy.
Ten eyes of 10 patients were enrolled. The mean patient age was 23,8 (16-31). The mean preoperative Kmax was 47,4 ± 2,9 D and the mean corneal thickness at the thinnest point was 467 μm ± 44. At 3 months, a posterior demarcation line was visible in 9 eyes (90%) with a mean depth of 414 μm ± 80,91 with AS-OCT and 397 μm ± 148 with SS-OCT (85,7 % of mean corneal full thickness). We also observed, more anteriorly, a hyperreflective band reaching the depth of 213 μm ± 42 with AS-OCT. Compared to baseline, the corneal sub-basal nerve density had significantly decreased and superficially keratocytes apoptosis was observed at 3 months postoperatively. Indeed, there were no statistically significant differences between the mean endothelial cell counts before and 6 months after CXL. No intraoperative, neither postoperative complication were observed.
Previous work suggests that the supplementary oxygen strategy might increase the aerobic type II reaction, enabling a potentially deeper and more effective CXL. The posterior demarcation line depth we found in our study, despite the absence of epithelial debridement, does confirm this hypothesis. We can assume that the hyperreflective anterior band we visualized was a change in corneal refractive index. Occurring in the strongest corneal part with closer collagen fibers and decreased in water content, we hypothesized the healing process could be amplified in that area. The posterior demarcation line remains probably the posterior limit of CXL biological interaction. Transepithelial oxygen boosted CXL could provide a deep corneal photo reticulation, avoiding the drawbacks of epithelium removal. Further complementary studies are necessary to confirm the long-term safety and efficacy.
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P203
USE OF AUTOLOGOUS PLATELET-RICH PLASMA (PRP) EYE DROPS FOR THE TREATMENT OF PERSISTENT CORNEAL LESIONS UNRESPONSIVE TO CONVENTIONAL THERAPIES.
Mario Troisi
Cornea
Mario

TROISI
Italy
Purpose of the study is to evaluate the efficacy and safety of treatment with topical PRP in corneal lesions unresponsive to therapy with tear substitutes and ointments or therapeutic contact lenses, planned for amniotic membrane implantation.
Salerno Univerity Hospital - Ophthalmologic Unit

Selected patients had persistent corneal lesions (diameter 1-4 mm) unresponsive to conventional therapies over 14 days. Exclusion criteria: conjunctival swab positive for bacteria or fungi; positivity of markers for hepatitis or HIV, abnormal blood count. The PRP eye drops, obtained from the autologous blood, centrifuged at 1600 rpm, was instilled every 2 hours for up to six weeks for 10 times/day until complete re-epithelialization of the lesion. Clinical follow-up was scheduled twice a week.
Twenty consecutive patients were treated (12 males, 8 females; mean age 46 years): 9 following infection, 6 post-traumatic forms, 5 with neurotrophic keratitis. Complete re-epithelialization occurred in 19 of them within 5 weeks; the mean healing time was 22 +/-7 days. One patient underwent amniotic membrane implantation and tarsorrhaphy after 6 weeks due to incomplete therapeutic efficacy. No patient experienced effects or corneal neovascularization that required therapy discontinuation.

The use of autologous PRP eye drops was effective and well tolerated; in our opinion it constitutes an interesting alternative to more invasive procedures in patients with persistent corneal lesions unresponsive to conventional topical therapies.
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P204
TOXIC ANTERIOR STROMAL KERATITIS AFTER SYSTEMIC ALLERGIC REACTION TO LIDOCAINE
Ana Rita Viana
Cornea
Ana Rita

Viana
Portugal
Hypersensitivity reactions to local anesthetics, particularly lidocaine, are rare. This report describes the clinical case of a young adult woman who presented with an atypical ocular manifestation, presumably related to a systemic hypersensitivity reaction after local injection of lidocaine.
Ophthalmology Department of Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Portugal.
Clinical case report.
A 42-year-old female with supraspinatus tendinosis was submitted to a local injection of methylprednisolone acetate and lidocaine hydrochloride in her left shoulder. She was otherwise healthy. A few minutes after the injection, the patient developed generalized weakness, tremors, palpitations, precordial discomfort and an itchy rash on her hands and feet and was sent to the emergency department. It was assumed as an allergic reaction to lidocaine and the patient was treated with intravenous hydrocortisone and clemastine with rapid relieve of her symptoms. During the night, the patient developed bilateral photophobia, ocular pain and conjunctival hyperemia. At the ophthalmological examination, she presented a corrected distance visual acuity of 20/20 and normal intraocular pressure in both eyes. During slit lamp observation, it was noted a discrete bilateral 360º peripheral anterior stromal corneal opacity. The patient was medicated with oral prednisolone 20 mg and cetirizine 20 mg, topical unpreserved dexamethasone 0.1%, topical cyclopentolate 1% and ocular lubrification. The next day she showed ocular symptoms relieve but the corneal opacity extended centrally, showing a diffusely distributed bilateral anterior stromal haze and reduced transparency, without signs of uveitis. The anterior segment optical coherence tomography demonstrated a homogenous hyperreflectivity localized on the anterior half of the corneal stroma. During follow-up time, the patient showed a favorable response to the medical treatment.
The initial perilimbal location of the corneal opacity, adjacent to the terminal capillary loops of the limbal vascular arcades, is compatible with an immune-related etiology, in this case probably related with a hypersensitivity reaction to lidocaine. Corticosteroids are the mainstay of therapy for the most common forms of interstitial keratitis and showed effectiveness in controlling the acute inflammatory symptoms and promoting the resolution of the condition.
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P205
PERIPHERAL ULCERATIVE KERATITIS AND SEQUENTIAL NECROTIZING SCLERITIS IN A PATIENT WITH GRANULOMATOSIS WITH POLIANGIITIS.
Javier Vicente Andreu
Cornea
Javier

Vicente Andreu
Spain
To report a case of a patient with Orbital Vasculitis (OV) in the setting of Granulomatosis with Poliangiitis (GPA) in which a Peripheral Ulcerative Keratitis (PUK) and sequential Necrotizing Scleritis (NS) were observed.
An 80-year-old female diagnosed with GPA with cutaneous, upper and lower respiratory tract and kidney involvement initially treated with Azathioprine. In the course of the disease, she presented with a right orbital B-cell lymphoma and was treated with Rituximab and orbital radiotherapy, with partial response. The patient declined second-line therapy afterwards and she was controlled with magnetic resonance imaging (MRI) showing stability. Patient lost follow-up and came back to consultation ten months later with a painful right eye.

Best corrected visual acuity (BCVA), slit lamp examination (SLE), intraocular pressure (IOP), dilated fundus examination (DFE), and magnetic resonance imaging (MRI).
At presentation BCVA was counting fingers on the right eye and IOP was normal. The patient had exotropia and all ocular movements were impaired. SLE showed a superonasal crescent-shaped PUK with marked corneal thinning. The adjacent sclera was hyperemic without nodules or thinning. There were no remarkable DFE findings and MRI showed stability of orbital lesions. Intravenous Methylprednisolone (IVMP) was administered for 3 days. Posteriorly one intravenous Cyclophosphamide pulse was given. There was a good response with improvement of BCVA (20/70) and healing of the PUK area and she was discharged with oral Cyclophosphamide and Prednisone in a tapering regime. She did not attend further follow-up and came back six weeks later with complete healing of PUK but new onset nodular scleritis. IVMP was again administered with good response. The patient lost follow-up again and came three months later to the emergency department with a painful right eye. SLE revealed a NS with marked scleral thinning in the same location of prior nodular scleritis. Neither decrease in VA nor posterior scleral involvement were found. IVMP was given with significant improvement and oral Cyclophosphamide was re-started.
GPA is a severe multisystemic autoimmune disease that is defined by granulomatous inflammation and vasculitis in small and medium-sized vessels. Ocular and orbital manifestations are common in these patients and can potentially involve every structure with a wide range of severity. High-dose immunosuppressors are often needed during flare-ups and multidisciplinary management is key to ocular function preservation. OV, PUK and NS are examples of severe ocular manifestations of GPA that happened nearly simultaneously in our patient and were successfully treated with high-dose corticosteroids and Cyclophosphamyde despite low adherence to treatment and follow-up.
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P206
COMBINED CONJUNCTIVAL AUTOGRAPH TRANSPLANTATION AND AMNIOTIC MEMBRANE OVERLAY IN PTERYGIUM SURGERY
Leyre Zabala
Cornea
Leyre

Zabala
Portugal
The treatment options of pterygium surgery have been studied for many years but many uncertainties still exist. Conjunctival autograft surgical technique (CAT) is the treatment of choice although there is still a documented high rate of recurrence. Amniotic membrane (AM) anti-inflammatory and analgesic properties can be useful in the reduction of the recurrence rate. The purpose of this study is to show a combined CAT and AM overlay technique as well as the post-operative results in a group of 10 high risk pterygium patients with a minimum follow up of 6 months.
To reduce post-operative recurrence rates after CAT, adjuvants such as mitomycin C and others have been used. Nevertheless they have been associated with higher risk of post-operative severe ocular complications. AM over bare sclera surgical technique has proven to be effective although with a higher rate of recurrence than CAT. We believe that AM documented analgesic properties can reduce pain and accelerate the healing process. Furthermore, AM anti-inflammatory properties can decrease the rates of pterygium recurrence when combined with CAT as an overlay.
Ten high risk of recurrence primary pterygium patients underwent pterygium surgery with the CAT with AM overlay surgical technique. The inclusion criteria for high risk patients were: younger age, darker skin complexion, male sex, outdoor job or leisure activities. After infiltration of the operating sites with lidocaine 2% with adrenaline careful dissection and excision of the pterygium and the surrounding Tenon was performed. A conjunctival epithelium autograft of the same size was removed from the superior bulbar conjunctiva and applied to the bare sclera with fibrin glue. An AM graft was then applied over the conjunctival autograft and secured with 10/10 nylon sutures hidden in the superior and inferior conjunctival fornixes. The eye was then padded for 24h. Post-operative treatment was initiated on the next day with tobramycin and dexamethasone eyedrops as well as preservative free artificial tears and an eye shield was recommended for protection at night time. Postoperative visits were scheduled at day 1 and 7 and at month 1,3,6 and 12. They included a slit lamp evaluation as well as a pain assessment questionnaire.
None of the patients complained of moderate to severe post-operative pain. Two patients complained of itchiness in the site of the sutures. None of them needed to take painkillers. There were no cases of moderate to severe inflammation. There were no cases of recurrence of pterygium. There was 1 case of a small conjunctival retention cyst
Combined conjunctival autograft transplantation and amniotic membrane overlay technique in pterygium surgery can be effective in the immediate post-operative period by reducing pain as well as in the long term outcomes by reducing the rates of pterygium recurrence. Further randomized controlled trials are needed to prove the benefits of this technique over CAT alone.
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P207
CAPSULAR BAG TRANSPLANTATION
Amani Abbas Khoja
Miscellaneous
Amani

ABBAS KHOJA
Spain
To describe the surgical process of extraction of the capsular bag of the crystalline lens from the cadaveric donor and its posterior implant in aniridia and aphakia cases
La Mancha-Centro Hospital
This surgical procedure was used in three posttraumatic aniridia and aphakia patients, and in a aphakic case with uveitis-glaucoma- hyphema (UGH) syndrome. In a case was implanted a capsular bag, an intraocular lens (IOL) and an aniridia ring. In two cases in addition was implanted an artificial iris prothesis. In three surgeries, the capsular bag was preserved by freezing prior to the operation. A pars plana vitrectomy was performed in each case. The in-the-bag IOL complex was fixed using a cow hitch knot technique.
The pseudophakic capsular bags complex remained stable and well positioned in all cases without any rejection phenomena. In the UGH syndrome, the capsular bag transplant avoided the mechanical trauma of the IOL over adjacent anatomical structures.
Capsular bag transplant could be a good option in posttraumatic aniridia with aphakia and in UGH syndrome, to resolve these conditions in only one-stage surgery. This new surgical technique could be the best way to recuperate the anatomical compartmentalization of the eyeball in such cases.
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On-demand

P208
SCLERAL FIXATED INTRAOCULAR LENS IMPLANTATION IN A PATIENT WITH BILATERAL MICROCORNEA AND MICROPHTHALMIA: A CASE REPORT
Nada Nasser Al Wohaibi
Miscellaneous
Nada
Nasser
Al Wohaibi
Saudi Arabia
Microphthalmos is a developmental anomaly consisting of a smaller than normal eye, which can be associated with other ocular abnormalities such as congenital cataracts and nystagmus.
Management of aphakia in microphthalmic eyes is challenging due to the anatomical abnormalities and limited literature on managing such cases. Visual rehabilitation for aphakia using contact lenses is limited by intolerance and poor lens fitting. Significant optical aberrations may limit aphakic spectacle use, further exacerbated in patients with nystagmus. Thus, secondary IOL implantation seems to be a reasonable rehabilitation alternative; however, it is surgically challenging in microphthalmic eyes.
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Here, we report a case of a 22-year-old lady with bilateral microphthalmia and microcornea, in which a modified technique for sutureless scleral fixated intraocular lens implantation provided a successful aphakic rehabilitation alternative with a good visual outcome and significant improvement in quality of life.
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P209
EVIDENCE BASED PREDICTION AND PROGRESSION MONITORING ON RETINAL IMAGES FROM THREE NATIONS
abdulrahman zaid alshamrani
Miscellaneous
Abdulrahman
zaid
alshamrani
Saudi Arabia
The aim of this work is to demonstrate how a retinal image analysis system, DAPHNE, supports the optimisation of diabetic retinopathy (DR) screening programmes for grading colour fundus photography
DAPHNE, developed by the Department of Computer Science, University of Surrey, UK, automatically analyses characteristics of DR and DMO using both International and UK grading schemes (ICDRS and NSC) to facilitate the use of such system in various clinical settings. In DAPHNE, deep learning architectures were established to learn about different levels of features related to DR severity as well as the key markers associated to DMO. It first measures the quality of the input images then reports the findings through multiple detections. Every images will be analysed even if it is assessed as being of poor quality. This is to accommodate the fact that many poor quality images often result from significant pathology. DAPHNE outputs the analysis of the image on the quality level, grading level based on both ICDRS and NSC and measurement of suspected DMO.
Retinal image sets, graded by trained and certified human graders, were acquired from Saudi Arabia, China and Kenya. Each image was subsequently analysed by the DAPHNE automated software. The sensitivity, specificity, positive and negative predictive values for the detection of referable DR and/or diabetic macular oedema were evaluated, taking human grading or clinical assessment outcomes to be the gold standard. The automated software's ability to identify co-pathology and to correctly label DR lesions was also assessed.
In all three datasets the agreement between the automated software and human grading was between 0.84 to 0.88. Sensitivity did not vary significantly between populations (94.28% to 97.1%) with specificity ranging between 90.33% to 92.12%. There were excellent negative predictive values above 93% in all image sets. The software was able to monitor DR progression between baseline and follow-up images with the changes visualised. No cases of proliferative DR or DMO were missed in the referable recommendations.
The DAPHNE automated software demonstrated its ability not only to grade images but also to reliably monitor and visualise progression. Therefore, it has the potential to assist timely image analysis in patients with diabetes in varied populations, and also help to discover subtle signs of sight-threatening disease onset.
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P211
EXOPHTHALMOS REVEALING A RARE LOCALIZATION OF A SALIVARY PLEOMORPHIC ADENOMA
Arazzakou Amira
Miscellaneous
Arazzakou

amira
Morocco
to report a case about an Exophthalmos revealing a rare location of a salivary pleomorphic adenoma
Exophthalmos is a protrusion of the eyeball in front of the orbital bone frame. It usually reflects an increase in orbital contents within the rigid bony orbit. Pleomorphic adenoma or mixed tumor is defined as a benign heterogeneous tumor of the salivary glands. The most common site is the parotid gland. It is rare reported in the minor salivary glands.

Ophthalmology department of the 20 aout 1953 of the university hospital, university hospital center IBN ROCHD,
Faculty of Medicine and Pharmacy of Casablanca,Morocco.

We report the case of a 62-year-old patient, with no particular pathological history, who presented for an exophthalmos of the left eye with mild malar swelling.
Slit lamp examination of the affected eye showed a visual acuity of 8/10 with normal eye tone, a moderate exophthalmos, deviated to the left, non-pulsatile, non-irreducible, painless, without inflammatory signs with slight esotropia, and superficial punctate keratitis.
Fundus Examination was normal.
Orbital MRI objectified a tumor mass in the maxillary sinus responsible for a grade II exophthalmos.
The biopsy concluded to a pleomorphic adenoma of a salivary gland.
Exophthalmos is common in ophthalmologic consultation.
The inspection is able to define its unilateral or bilateral, pulsatile or non-pulsatile character.
If a tumor growth is suspected, an imaging assessment will be requested.
The biopsy confirms the diagnosis guides the management
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On-demand

P212
DISTRIBUTION OF OCULAR HIGHER ORDER ABERRATIONS FOR TWO AGE GROUPS
Gerd Uwe Auffarth
Miscellaneous
Gerd
Uwe
AUFFARTH
Germany
To investigate the distribution of ocular higher order aberrations in healthy eyes for a younger and an elderly population.
Dept. of Ophthalmology, University of Heidelberg, Germany
In this ongoing study, phakic eyes without any known ocular pathologies were measured with the Pentacam AXL Wave. These Measurements (only measurements with good quality scores were included) were retrospectively analysed according to the ocular higher order aberrations (HOA). The data was clustered with respect to the age of the patients into two groups – a younger (≤ 50 years) and an elderly (> 50 years) group. The HOA of the 3rd and 4th order (Trefoil, Coma and Spherical Aberrations) were analysed always for the optical zones of 2, 3 and 4mm. Mean values and standard deviations were calculated for both study groups, means were compared with an independent t-test
Until now 216 patients (179 right and 174 left eyes) took part in this study. The younger (Y) group consists of 191 eyes and the patients were on average 32 ±9,4 years old. In the elderly (E) group 162 eyes were included and patient were on average 65 ±10,2 years old. Trefoil2mm: mean=0,018Y/0,043E µm* ±0,012Y/0,044E; Trefoil3mm: mean=0,037Y/0,072E µm* ±0,024Y/0,052E; Trefoil4mm: mean=0,059Y/0,108E µm* ±0,037Y/0,066E; Coma2mm: mean=0,033Y/0,043E µm* ±0,014Y/0,037E; Coma3mm: mean=0,032Y/0,059E µm* ±0,022Y/0,049E; Coma4mm: mean=0,059Y/0,099E µm* ±0,036Y/0,066E; SA2mm: mean=0,004Y/0,005E µm ±0,008Y/0,021E; SA3mm: mean=0,012Y/0,025E µm* ±0,013Y/0,031E; SA4mm: mean=0,028Y/0,057E µm* ±0,034Y/0,049E. An asterisk indicates a significant difference (p<.05) between the means
It could be confirmed that elderly eyes have statistically significant greater ocular higher order aberrations than younger. This finding was consistent for Coma, Spherical Aberrations and Trefoil regardless of the size of the optical zones analysed, except one case. This ongoing study provides an excellent basis in order to establish normative data for HOA. However, a much greater population, including patients of all age groups, must be examined so that a more meaningful clustering, e.g. 10 years steps, can be applied
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P213
PERIORBITAL EDEMA REVEALING A NASOSINUSAL CHONDROSARCOMA
F. Bahari
Miscellaneous
Fatimazahrae

Bahari
Morocco
To present a case of nasosinusal chondrosarcoma revealed by a Periorbital edema.
Adult Ophtalmology Department of 20 August University Hospital, Casablanca, Morocco
A 25-year-old patient, with no particular pathological history, presented for significant periorbital edema of the left eye. Facial examination revealed a facial asymmetry, a widening of the base of the nose and a fullness of the medial canthus of the left eye. Ophthalmologic examination of the left eye revealed an impossible spontaneous eye-opening, a grade II exophthalmos and a normal fundus exam. Ophthalmologic examination of the right eye did not show any abnormalities. The patient was conscious, with no sensory-motor deficit.
CT of the sinuses showed a mass lesion involving the nasal cavity and the left maxillary sinus with bone lysis and expansion to the nasopharynx and the left orbit. The biopsy of the nasal cavity concluded through the histological study to a sarcoma. The immunohistochemical study confirmed the diagnosis of chondrosarcoma. After 4 cycles of neoadjuvant chemotherapy, a complete removal of the tumor was performed with an additional external radiotherapy. The histological study was in favor of a chondrosarcoma grade II.
Chondrosarcoma of the paranasal sinuses is a rare and aggressive tumor with a slow growth. The occurrence of a significant periorbital edema associated with uni or bilateral nasal obstruction justifies the use of Facial imaging.
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P214
DR SQUIER LITTELL AND HIS WORK' A MANUAL OF THE DISEASES OF THE EYE'
Georgios N Balanikas
Miscellaneous
Georgios
N
Balanikas
Greece
Dr Squier Littell Jr. was one of the pioneers in Ophthalmology in America and his work was based in his long experience from his service in Wills Hospital as well as in his private practice. Dr Littell considered as the father of Ophthalmology in the United States
The facts took place at the Wills Hospital in the United States and this presentation was conceived and realized mainly in the first Ophthalmologic Clinic of Aristotle University of Thessaloniki
The first and second edition (1837, 1848 Philadelphia) from the work of S. Littell's (1803-1886) 'Manual of the diseases of the eye' are the main sources for this presentation. His surgical skills, his educational and writing work are also objects of study of the present work. Biographical data are derived from the 1887 'Memoir of Squier Littell M.D.' written by his son-in-law, Andrew Douglass Hall, published in 1887 in the Transactions of the College of Physicians of Philadelphia.
Dr Littell was a founding member of Wills Hospital's surgical team 'For the Indigent Blind and Lame' from 1834. Three years later his work 'Manual of the Diseases of the Eye' was published based on his experience at Wills Hospital as well as his private. Littell's work was a milestone in the literature and practice of Ophthalmology in the 19th century, especially in English-speaking countries.The second edition appeared in 1846 and Littell was now recognized as a skilled ophthalmologist who contributed to the development of Ophthalmology with his important articles and articles in scientific journals and other books.
Squier Littell Jr. is widely regarded as the father of Ophthalmology and with his work 'Manual of the diseases of the eye', he marked the American literature and education, based on the rich experience he gained during his long tenure at Wills Hospital. He was also one of the first surgical team at Wills Hospital, which established its reputation as one of the most brilliant Ophthalmological Institutions in the world. A pleasant surprise is the addition to his book of the vocabulary of the medical terms using, along with, and among others, their Greek etymological origin and Greek characters.
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P215
ANKYLOBLEPHARON FILIFORME ADNATUM
Lina Boualila
Miscellaneous
Lina

BOUALILA
Morocco
Presenting a rare congenital eyelid abnormality and exposing the various malformations that may be associated with it.
Ophthalmology A department, Ibn Sina hospital, Rabat, Morocco
A 2-months newborn was sent by the pediatrician for an ophthalmological examination, for presenting a skin bridge between eyelids of the right eye.The baby was born from a non-consanguineous marriage, at 40 weeks gestational age and weighed 3500 g. No particular medical family history. Pregnancy and delivery were unremarkable. The somatic examination found no abnormalities: no cardiac malformation, no central neurological abnormalities, no cleft lip or palate, no ectodermal syndromes. The ophthalmological examination found an ankyloblepharon filiforme adnatum. The patient was classified type I, according to Rosenman classification.
The baby underwent an incision of the ankyloblepharon under sedation in one cut. No underlying ocular abnormalities were noted.No systemic or ocular sequelae were reported after two years of follow‐up
Ankyloblepharon filiforme adnatum can be isolated or associated with multiple malformations and be a life-threatening disease. The surgical treatment has to be early, to prevent amblyopia and guarantee a better cicatrization.
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P216
AQUEOUS CHEMOSIS IN NEPHROTIC SYNDROME
Neama Bouhazzama
Miscellaneous
Neama

Bouhazzama
Morocco
Aqueous chemosis = white chemosis is defined as edema of the bulbar conjunctiva.
Main etiology: allergic reaction.
Rare and reversible complication of nephrotic syndrome, it occurs mainly in children. We report a case of aqueous chemosis in the context of a nephrotic syndrome seen in the ophthalmological emergency department of the August 20th 1953 Hospital.
ophthalmology department; August 20th,1953 hospital Ibn Rochd University Hospital Center Faculty of Medicine and Pharmacy Casablanca Hassan II University (Morocco)
Our patient is a 42-year-old man , followed in nephrology for extra capillary glomerulonephritis. The ophthalmologic examination found: Visual acuity maintained at 10/10 in both eyes, Ocular motility preserved, Photomotor reflexes present and symmetrical slit lamp: Bilateral, non-inflammatory aqueous chemosis, more pronounced in the left eye (temporally), Anterior segment: calm, Fundus: papilla with clear contours and normal coloring, normal cup/disc and macula in both eyes. In addition, the general clinical examination found: Blood pressure rise (160/100 mmHg) Pleural effusion syndrom Edema of the lower limbs Biology report: Hypoprotidemia: 35g / L Deep hypoalbuminemia: 22g / L Proteinuria: 15g / 24h Renal function: preserved (Cl = 50) Chest x-ray: bilateral pleural effusion Abdominal ultrasound: slight intraperitoneal fluid effusion, with slight nephromegaly

The diagnosis of nephrotic syndrome in the setting of glomerulonephritis led to the administration: diuretic treatment, anti-thrombotic, and corticosteroid therapy. No local ophthalmologic treatment was prescribed. Good clinical-biological evolution and in particular a regression of bilateral chemosis. Aqueous chemosis is a rare and unusual complication of nephrotic syndrome in adults. Two cases of bilateral aqueous chemosis in nephrotic syndrome have been reported in the literature in a 15-year-old child and in a 3-year-old goat. Chemosis, or conjunctival edema, can be inflammatory or non-inflammatory. Non-inflammatory (watery) chemosis is most often secondary to an allergic reaction.

Aqueous chemosis in nephrotic syndrom is a rare but benign complication. It is believed to be secondary to fluid retention due to hypoprotidemia. No local treatment is indicated, and the regression of chemosis would be concomitant with the disappearance of the clinico-biological nephrotic syndrome.
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P217
BINOCULAR DIPLOPIA REVEALING THROMBOSIS OF THE LATERAL SINUS: ABOUT A CASE
Anass Boujaada
Miscellaneous
Anass

Boujaada
Morocco
dural sinuses. Initially described by Ribes in the early 19th century.
Septic venous thrombosis of the lateral sinus of otogenic origin is a frequent and serious complication of mastoiditis, described in children. Adult mastoiditis is rare, complicated by thrombosis septic lateral sinus in 3% of cases.
We report here the observation of a patient seen at the ophthalmology consultation for diplopia, and
whose radiological work-up revealed thrombosis of the lateral sinus of otogenic origin.
Department of Ophthalmology B. Specialty Hospital of Rabat
This is a 15-year-old girl with a history of recurrent left otitis, consulting emergency for headaches associated with binocular diplopia and visual blurring. The ophthalmological examination objected: visual acuity was 7/10 in the right eye and 8/10 in the left eye. Ocular mobility retained in both eyes. Examination of the anterior segment is unremarkable. The fundus revealed bilateral papillary edema of stage II stasis. The patient also reported left otalgia and dizziness, so an ENT examination was requested objectifying purulent otorrhea, fetid on the left with an inflammatory external ear canal, painful inflammatory retroauricular swelling, and a fever at 39°C.
A brain scan was done to look for a cerebral meningeal complication. The CT showed two retroauricular hypodense collections enhanced peripherally containing air bubbles. First collection was communicating with the mastoid, site of an abscess through bone lysis, which is in contact with the left lateral sinus, this sinus contains air bubbles with defect of enhancement in c + suggesting a thrombophlebitis. the second collection is more posterior measuring 17x7 mm
An anti-coagulation by low molecular weight heparin (LMWH) at a curative dose associated with an
antibiotherapy based on ceftriaxone 2g / day and mitronidazole 500mgx 3 / day were prescribed. The excision posterior for the infected cholesteatoma was performed.
Antibiotherapy and anti-coagulation allowed rapid regression of clinical signs.
Lateral sinus thrombosis is a serious complication of middle ear infection. The diagnosis is based on clinical examination and imaging (CT). Treatment is currently widely known in; combining antibiotherapy, anticoagulant treatment and surgical means; which made it possible to reduce 0-16% mortality.
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P218
IMPACT OF CIGARETTE SMOKING ON OCULAR SURFACE AND MEIBOMIAN GLAND FUNCTIONAL AND MORPHOLOGICAL CHARACTERISTICS
Ana Rita Carreira
Miscellaneous
Ana Rita

Carreira
Portugal
Our aim was to assess the effect of smoking on ocular surface, tear film stability and meibomian gland functional and morphological characteristics.
Hospital Garcia de Orta E.P.E, Almada, Portugal
This study included healthy age-matched non-smokers and current cigarette smokers. Symptoms (Ocular Surface Disease Index (OSDI) questionnaire and symptoms score) and signs (Schirmer test I, Tear Film Break-up Time Test (TBUT), corneal fluorescein staining (CFS) score) of dry eye disease (DED) were determined. Lipid layer thickness (LLT) and Meibomian Gland Disfunction (MGD) grading were also assessed (slit-lamp examination and LipiView interferometer).
Twenty eyes were included in the Non-smokers group, with a mean age of 40.03±6.78 years, and 21 in the Smokers group, with a mean age of 42.24±3.51 years (p=0.08). Smokers group had higher proportion of DED diagnosis (10 vs 100%, p<0.001), with higher OSDI (10.60±2.12 vs 14.27±2.60, p=0.04) and CFS (3.01±0.42 vs 7.00±1.03, p=0.001) scores and lower TBUT values (12.23±1.34 vs 5.42±1.76s, p<0.001). MGD diagnosis proportion was higher in Smokers group (0 vs 47.62%, p<0.001), with greater Meibo-score (p<0.001) and lid abnormality score (p=0.01). LLT measurement was lower in Smokers group (64.02±1.87 vs 39.02±5.66nm, p=0.01). Smoking index was correlated with TBUT, Meibo-score and LLT (p<0.05).
Smoking negatively affected the ocular surface and meibomian glands, with a higher level of eye dryness, gland dropout and lipid tear film layer deficiency.
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P219
SUBTHRESHOLD NANOSECOND LASER, FROM TRIALS TO REAL-LIFE CLINICAL PRACTICE: A COHORT STUDY
Hasan Chichan
Miscellaneous
Hasan

Chichan
Germany
Publication : https://pubmed.ncbi.nlm.nih.gov/33986589/
Age-related macular degeneration (AMD), a degenerative disorder, is a major cause of irreversible severe visual deterioration in the older Western population. Thus, treatments that resolve drusen may prove helpful in limiting the progression of AMD. The study aimed to evaluate the clinical outcome of sub-threshold nanosecond laser therapy (SNL) using a double-frequency nanosecond-pulsed laser with discontinuous energy beam distribution in the early stages of age-related macular degeneration (AMD).
This study was conducted in a single center in Cologne, Germany and was designed as a cohort study and performed in accordance with good clinical practice (International Conference on Harmonization of Technical Requirements of Pharmaceuticals for Human Use (ICH) E6) and the Declaration of Helsinki II. All patients were fully informed in detail about the therapy and the possible complications, and written informed consent was obtained from all patients before initiation of the treatment. According to national medical regulations for observational single-center studies, the Ethics Committee of the University of Cologne ruled that approval was not required for this study. All tenets of the Declaration of Helsinki and applicable national regulations and laws were observed.
In a single-center cohort study, 64 eyes with early or intermediate AMD were treated using SNL and then compared to 77 untreated, control eyes. The primary outcome measures included the area and amount of drusen, and the secondary outcome measures included change in visual acuity and rate of drusen progression within 6 months of follow-up.
A total of 64 patients' eyes following SNL treatment showed a significant reduction in the area and amount of drusen after 6 months in comparison to the corresponding values in the control group (p<0.001, respectively). There was no significant difference in visual acuity change after 6 months in both groups (p0.59, respectively). Within the 6-month follow-up, the rate of progression in drusen size and number was significantly lower in the SNL group (26%) than in the control group (69%; p<0.001).
SNL therapy is a novel, promising approach for improving the macular morphology in patients with early and intermediate AMD. Further studies are necessary to reveal the potential to reduce the risk of transformation into advanced or wet AMD and to retain vision.
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P220
INTERFACE FLUID SYNDROME AFTER LASIK : A POTENTIAL LONG-TERM REFRACTIVE SURGERY COMPLICATION. A CASE REPORT
Pablo Andres Cisneros Arias
Miscellaneous
Pablo
Andres
Cisneros Arias
Spain
To describe a case of a patient with history of LASIK surgery who develops interface fluid syndrome (also known as intraocular pressure (IOP)-induced interlamellar stromal keratitis) and the importance of obtaining an appropriate diagnosis to perform a correct treatment.
LASIK surgery patients may present interface fluid syndrome as a potential complication. In general, the cases described tend to occur within a few months of performing the technique. However, in the context of uveitis, silent glaucoma, or corticosteroid treatment, some cases have been described several years after surgery.
We present the case of a 43-year-old woman with diabetic retinopathy and a history of LASIK surgery 14 years ago, who came to the emergency room with decreased visual acuity (VA) in the left eye after being treated with an intravitreal corticosteroid implant. Her left eye pressure was 36 mm Hg. After the examination, she was diagnosed with interface fluid syndrome in her left eye.
The treatment consisted of lowering intraocular pressure. Topical timolol, oral acetazolamide, bimatoprost, and brinzolamide were used. After monitoring intraocular pressure, the patient recovered her baseline VA.
This case shows the importance of considering this diagnosis in patients with a history of LASIK surgery who present elevated IOP and corneal haze in order to establish an adequate treatment, which in this case is to lower the eye pressure. In general, a full recovery is expected.

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P221
COMPUTER BASED PERCEPTUAL VISION THERAPY FOR VISUAL IMPROVEMENT IN AMBLYOPIA
Lional Raj Daniel Raj Ponniah
Miscellaneous
Lional Raj

DANIEL RAJ PONNIAH
India
The aim of this study is to evaluate the effect of the Neuro-vision therapy for visual improvement in amblyopic patients
An Exploratory Clinical Trial at the department of Paediatric Ophthalmology in a tertiary Eye Hospital
This Neuro-vision therapy was aimed at improving the brain's image processing to regain the decline in visual acuity due to amblyopia. Patients were treated for 80 sessions (45 to 90 min each) for a period of 6 months with the program . Unilateral amblyopia with BCVA upto 20/100 and bilateral amblyopia with BCVA upto 20/200 with any amblyogenic background with intact cognition were included for the study. Squint with deviation more than 12 prisms, vision below 6/60 and age more than 60 years were excluded. This is a stand-alone therapy without occlusion therapy. The patients were given a daily program for home training with software. BCVA were recorded using ETDRS chart during each visit
20 patients (28 eyes; 8 bilateral & 12 unilateral) with amblyopia aged above 9 years were recruited. Baseline BSCVA was 36.43 ETDRS letters and significantly improved during months 1,2,3.4,5 and month 6 visits as 39.82, 43.25, 46.11, 48.89, 51.39 and 53.25 respectively (P<.0001).A one way repeated measures ANOVA was conducted to evaluate the null hypothesis that there was a change in visual acuity parameters when measured at baseline, Months 1 through 6. The results of the ANOVA for amblyopia indicated a significant time effect, Wilk's Lambda = 0.109, F (6, 22) = 29.979, p<0.0001
There was significant visual acuity gains in patients with amblyopia on completion of the program. The enhancement of visual process is likely by stimulation of specific neurons in visual cortex, thereby establishing a new neural connection at the synapse level. The improved vision endured for a longer period with this amblyopia management system
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P222
EARLY RESULTS AFTER OF MICROSTENT HYDRUS COMBINED WITH CATARACT OPERATION AND
STANDALONE PROCEDURE IN PSEUDOPHACIC EYE
Magda Rau
Miscellaneous
Magda
Rau
Rau
Germany
Assessment of reduction of IOP and number of medication after implantation of Hydrus (Ivantis) in the patients with open angle glaucoma. The implantation was performed combined with cataract operation or a stand-alone procedure. Additionally the safety of the procedure was assessed
Augenklinik Cham,Germany
From October 2020 to January 2021 we have implanted at a single centre by a single surgeon with and without cataract surgery Micro Stent Hydrus (Ivantis )in 10eyes of 8 patients,in 2 combined with cataract surgery,8 implantation as Stand alone procedure in pseudophacic eyes.
The mean preoperative pressure IOP was 34,5 mmHg and average number of IOP lowering medication was 3.The IOP could be reduced on the first postoperative day to 12,9mmHg,after 6 months the average IOP was 12,4 mmHg.The number of mediacation could be reduced from 3 to 1 after 3 and 6 months.
Implantation of the Micro-Stent Hydrus in combination with cataract surgery or as stand alone procedure is a safe, microinvasive treatment of open-angle glaucoma .No patients experienced sight-threatening adverse events .With respect to reduction of IOP and glaucoma medications after 6 months , it is an effective and lasting procedure
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P223
A CASE OF SYPHILITIC RETINITIS IN AN IMMUNOCOMPETENT HOST
Meriem El Alami
Miscellaneous
Meriem

el alami
Morocco
Syphilis causes eye damage in 0.1 to 2.5% of cases. It can affect all eye structures. Syphilitic retinitis is a rare manifestation of secondary syphilis but it can be inaugural of the disease.
This work is about a case of syphilitic retinitis in a patient who consulted in ophthalmological emergencies of the hospital 20 August 1953 in casablanca.
The patien is a 48-year-old male, with a history of flu-like episodes for 3 months with dragging oro-pharyngeal pain, skin gummas and perforating plantar ulcer , who consulted urgently for a decrease in visual acuity of the right eye.
Clinical examination found: visual acuity of 4/10 , clear cornea, discrete tyndall, regular round pupil, clear crystalline, moderate hyalitis, vasculitis with extended necrosis range in temporal.
Fluorescein angiography found a temporal hyperfluorescent range associated with papillitis, peripheral vasculitis. Macular OCT was normal.Faced with this suspicion of acute retinal necrosis an extensive assessment was carried out. Only syphilitic serology came back strongly positive.
Anti-syphilitic treatment has been proposed according to current recommendations.Evolution: Within a few days, the treatment resulted in the disappearance of retinal necrosis, vasculitis and hyalite and a good clinical development of the dermatological lesions.
Syphilitic serology must be part of any retinal damage assessment, even when the appearance is very strongly suggestive of acute retinal necrosis of viral origin, especially in people with risky behaviours. Retinal involvement usually occurs during secondary syphilis.
Its treatment is based on penicillin G intravenously or Extencillin intramuscularly.
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P224
RHEGMATOGENOUS RETINAL DETACHMENT IN A CHILD WITH SLIT LAMP VISUALIZATION OF THE RETINA: ABOUT A CASE
Nihal El Arari
Miscellaneous
Nihal

EL ARARI
Morocco
Childhood retinal detachments constitute 5 to 12% of all retinal detachments, and the rhegmatogenous cause isn't common in this age group compared to adults.
The purpose of our case report is to shed light on this rare etiology in children and to show a particular case where the diagnosis was made just by examining with the slit lamp.

Our case is that of a 10-year-old child with no particular history, who presented to the emergency room four days after a sudden drop in visual acuity of the left eye without any notion of trauma. The admission examination found a visual acuity with negative light perception and an acuity of 10/10 of the right eye.
The slit lamp examination showed an anterior segment without abnormality with visualization of the retina and its vessels at the level of the anterior vitreous almost against the iris. A giant temporal tear was also observed.
The examination of the contralateral eye was without abnormality
An ultrasound supplement was performed objectifying a total retinal detachment with slightly thickened retina.
The child has been scheduled for emergency surgery.The visual acuity in immediate post-op has improved to low light perception.
Traumatism is the main cause of children retinal detachment. However the rhegmatogenic etiology should be raised , and requires the search for retinal dehiscences of the adelphe eye.
The diagnosis is usually made at the fundus examination of the eye, but in rare cases like our patient's, the retina can be visualized with the slit lamp when the retina detaches significantly.
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P225
GLAUCOMA IN STURGE WEBER SYNDROME
Iatissam El Belhadji
Miscellaneous
Iatissam

EL BELHADJI
Morocco
The aim of this report is to describe the case of a child with Sturge Weber syndrome with ocular involvement manifesting as unilateral open-angle glaucoma.
20th August Hospital, Ibn Rochd University Hospital Casablanca, Morocco
We report the case of a 10-years-old girl, with a history of unilateral facial port-wine stain since birth, and progressive seizures treated with carbamazepine, and diagnosed as Sturge Weber syndrome. The patient was addressed to our clinic for an ophthalmological consult with a complaint of progressive unilateral visual loss. Upon examination, there was a large hemifacial naevus flammeus mildly hypertrophic, and extending from the frontal to the mandibular area. Ophthalmic examination showed a visual acuity of 20/50 in the ipsilateral eye (right eye), compared to 20/20 in the left eye. Anterior segment examination and fundoscopy were unremarkable, apart from a cup/disk ratio of 8/10 in the right eye. Intraocular pressure was elevated in the right eye : 31 mmHg versus 17 mmHg in the left eye.
The main aim of the treatment was to control intraocular pressure (IOP) and prevent the progressive optic nerve damage and visual field loss. The patient was prescribed prostaglandin eye drops in order to lower IOP, and a dermatology consult was scheduled to treat the naevus with laser esthetically.
Glaucoma is one of the most common ocular complications associated with Sturge Weber syndrome, and represents the worst prognostic factor for visual function. It is important to perform a full ophthalmologic examination in these patients as most glaucoma cases are congenital, but it can also occur in young children and adults, and its management can be quite challenging despite medical or surgical treatment.
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P226
ACUTE ANGLE-CLOSURE ATTACK AS PRIMARY MANIFESTATION OF CHOROIDAL MELANOMA: A CASE REPORT
El Hadiri Rida
Miscellaneous
Rida

El Hadiri
Morocco
To report and discuss epidemiological, clinical and therapeutic aspects of a rare case of choroidal melanoma revealed by an acute angle-closure attack.
Mohammed V University, University Hospital Ibn Sina Rabat, Departement A of Ophthalmology, Morocco
we conducted a full clinical evaluation with ancilliary testing mainly an MRI of the orbit and brain with ocular ultrasonography. we documented the findings by slit-lamp photography and scans.
A 51-years-old male patient presented with a four day history of severe left ocular pain, redness and loss of vision. He denied any previous ocular or systemic illness. Visual acuity in the symptomatic eye was reduced to hand motion with increased ocular pressure estimated at 62mmHG and 360 ° angle closure on goniscopy. Upon biomicroscopic examination, we found diffuse conjunctival injection, perikeratic circle, diffuse corneal edema, shallow central anterior chamber, grade 2 Van Herick, fixed mid-dilated pupil, grade 2 nuclear sclerotic cataract. Funducopic examination revealed a bullous retinal detachment with a kissing configuration with numerous pigmented cells in the vitreal cavity. Examination of the fellow eye was unremarkable. B-scan echography showed a Mushroom-shaped hyperechoic lesion originating from the choroid with low internal reflectivity associated with an extensive exsudative retinal detachment with several pinpoint hyperechoic subretinal formations. The same lesion was highlighted by an orbito-cerebral magnetic resonance imaging. A presumptive diagnosis of complicated choroidal melanoma was made. Initial metatatic workup was negative. The acute angle-closure attack was initially managed by intravenous mannitol injection, oral acetazolamide and topical brimonidine and carteol. Lase peripheral iridotomy was avoided. The eye was enucleated 2 days later and showed a spindle B cell melanoma with heavy pigmentation and retinal detachment. There still no evidence of metastasis after 3-years of follow-up. Several mechanisms may cause ocular hypertension in the presence of uveal melanoma such as invasion or seeding of the angle, iris neovascularization and intraocular hemorrhage. Nevertheless, angle closure due to choroidal melanoma appears a very rare condition. We found rare cases worldwide reporting similar cases of acute angle-closure attack as primary manifestation of choroidal melanoma.
Clinicians should perform a complete ocular examination to rule out secondary etiologies of angle closure to initiate appropriate management. In presence of media opacities, B-scan echography is mandatory to evaluate an eventual mass formation or membrane detachment. The underlying etiology may be sight-threatening and lifethreatening. Thus, a prompt diagnosis allows instauration of an adapted therapeutic regiment. Laser procedures may be contraindicated in such cases to avoid tumor cell dispersion within the eye.
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P227
BILATERAL EPISCLERITIS AS THE FIRST PRESENTING SIGN OF ANKYLOSING SPONDYLITIS
Loubna El Kaissoumi
Miscellaneous
Loubna

EL KAISSOUMI
Morocco
The aim of our case is to underline the importance of ocular manifestations in ankylosing spondylitis.
A 27 years old man presented with the complaint of bilateral eye redness, mild ocular discomfort, without visual acuity loss. He had no previous medical history but reported gradually progressive low back pain since 2 months before presenting to our department. Eye examination revealed a bilateral episcleritis without any other abnormality.
A 27 years old man presented with the complaint of bilateral eye redness, mild ocular discomfort, without visual acuity loss. He had no previous medical history but reported gradually progressive low back pain since 2 months before presenting to our department. Eye examination revealed a bilateral episcleritis without any other abnormality. There was no inflammation in anterior and posterior segment. The visual acuity was conserved and a phenylephrin test was done to assess the diagnosis of bilateral episcleritis.
Lab tests revealed normochromic normocytic anaemia and an ESR -48mm/1st hour. The human leukocyte antigen (HLA) typing was positive for HLA B27. The diagnosis of ankylosing spondylitis was made according to the modified New York criteria.
Ankylosing spondylitis is a chronic inflammatory disease of insidious onset that usually begin with enthesis.The majority of episcleritis cases are idiopathic,but up to 36% of patients have an associated systemic disorder that is responsible for the pathological process and development of episcleritis.
It is important to insist on the anamnesis, especially among young adults presenting concomittant low back pain.
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P228
MULTIFOCAL TUBERCULOSIS COMPLICATED BY BILATERAL BOUCHUT'S TUBERCULOMA: A CASE REPORT.
Mohcine El Mhadi
Miscellaneous
Mohcine

El mhadi
Morocco
Tuberculosis is a transmissible infectious disease caused by Mycobacterium tuberculosis.
Extra-pulmonary tuberculosis accounts for 20% to 40% of all clinical forms, of which 1 to 2% are ocular involvement.
The ophthalmological disorders linked to tuberculosis are diverse, including Bouchut's tuberculoma.
The purpose of our observation is to emphasize the value of ophthalmologic examination, retinography as well as angiography in guiding the diagnosis of tuberculosis.
We report the case of a 29-year-old patient, hospitalized in the pneumology department for treatment of multifocal tuberculosis.
A gradual decrease in his visual acuity is reported 1 week after his hospitalization, prompting an ophthalmological consultation.
The corrected visual acuity was 9/10th in both eyes, and the intraocular pressure was 14 mmHg in the right and 15 mmHg in the left eye.
Fundus examination revealed in the right eye a yellowish protruding, para-macular formation (inferior temporal) with blurred outlines, measuring 1 papillary diameter (evoking a choroidal tuberculoma) with chorio-retinal folds, small flaming hemorrhage, and papillary edema. In the left eye, we found a serous retinal detachment with chorio-retinal folds, and papillary edema.
The patient had a fluorescein retinal angiography: the areas corresponding to the location of the tuberculoma shown an early Hypofluorescence, then a progressing hyperfluorescence from the periphery to the center of the lesions (roundel image). In late stages, the lesions show diffuse hyperfluorescence.
Mantoux and QuantiFERON TB Gold Tests are both positive.
Multifocal tuberculosis was retained on the association of pulmonary tuberculosis and Tuberculous spondylodiscitis.
Tuberculosis remains a major cause of worldwide death and morbidity. In Morocco there are around 25 thousand new cases per year.
The ophthalmological disorders linked to tuberculosis are diverse: all structures of the eye can be concerned (without a pathognomonic presentation).
There are clinical forms strongly suggestive of ocular tuberculosis such as Bouchut's tuberculoma.
On the etiopathogenic side, Bouchut's tuberculoma is linked to the hematogenous dissemination of Mycobacterium Tuberculosis as for all other organs.
Confirmation of ocular tuberculosis is based on evidence of Mycobacterium Tuberculosis in ocular tissues or fluids. However, the diagnosis is most often presumptive, based on a set of arguments (tuberculosis counting; clinical; radiological; Mantoux test; Quantiferon®; anti-tuberculosis treatment test).
Bouchut's tuberculoma can be a valuable aid in the diagnosis of systemic tuberculosis by a simple fundus examination.
Considering the possibility of asymptomatic clinical forms, the clinician should remember to request an eye fundus in any patient with pulmonary or extra-pulmonary tuberculosis, in order to detect ocular tuberculosis in time and avoid sequelae.
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P229
BENIGN CHONDROID SYRINGOMA OF THE ORBIT: A CASE REPORT.
Mohcine El Mhadi
Miscellaneous
Mohcine

El mhadi
Morocco
Mixed tumors of the skin have a dual component, one epithelial and the other mesenchymal, closely resembling mixed tumors of the salivary or lacrimal glands. In 1961 the term 'myxoid tumor of the skin' was replaced by 'chondroid syringoma (CS)' in order to differentiate the common mixed tumors of the salivary or lacrimal glands from those, much rarer, of the skin, originating in the sweat glands.
CS is localized mainly to the scalp, face and neck.
This tumor can also occur in the orbit, but its prevalence is minimal. Only one case of intra-orbital chondroid syringoma has been identified in the literature.
We report an unusual case of a patient presenting an intra-orbital chondroid syringoma evolving for 8 years, who consults for a unilateral exophthalmos with reduced left visual acuity.
It's a 41-year-old patient, with no notable pathological history, who consults for an exophthalmos of the left eye which has progressed for 8 years associated with a decline in visual acuity installed for 8 months.
The ophthalmologic examination of the left eye finds:
Painless, non-pulsatile, irreducible downward oblique proptosis with slightly limited abduction.
A visual acuity of 8/10 that cannot be improved.
An intraocular pressure at 16mmhg.
And a normal fundus.
The examination of the right eye is strictly normal with visual acuity of 10/10.
Examination of the visual field showed a decrease in sensitivity and limited narrowing of the visual field temporally in the left eye.
An orbital-cerebral computed tomography scan showed a well-circumscribed superolateral left orbital tumor without bone erosion. Magnetic resonance imaging revealed an extra-conical round mass with exophthalmos and medial optic nerve repression.
Our patient underwent surgery on her tumor by lateral orbitotomy with complete ablation. The diagnosis of Chondroid syringoma was confirmed by histopathology.
Chondroid syringomas (CS) are rare tumors of the skin appendages, slow growing, their preferred sites remain the head and the neck region.
Their orbital situation is exceptional, only one case has been listed in all the literature..
From a histological point of view, the characteristic epithelial and mesenchymal components allow the diagnosis to be made.
The radiologic signs of CS are not as suggestive as the histologic findings. MRI features are nonspecific, but they can accurately describe the anatomical extent and identify tissue of origin and depth of relative invasion to adjacent structures.
The differential diagnosis in our case is with other benign orbital lesions.
The treatment of choice remains complete excision. In our patient, the tumor was completely excised without recurrence after a follow-up of one year.
Chondroid syringomas remain an extremely rare entity but not excluded in the diagnosis of intra-orbital tumors. Complete excision is the most effective treatment method. Although malignant forms of these tumors and cases of recurrence are very rare, long-term follow-up remains an obligation.
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P230
RIGHT ORBITAL CELLULITIS REVEALING A BRAIN ABSCESS: A CASE REPORT.
Mohcine El Mhadi
Miscellaneous
Mohcine

El mhadi
Morocco
Orbital cellulitis is an inflammation of the orbital and periorbital cell tissues, often secondary to a periocular bacterial infection.
Two types of cellulitis are to be distinguished: preseptal cellulitis in front of the orbital septum and retroseptal cellulitis or 'true' orbital infection behind the orbital septum.
It is a serious pathology that can involve both visual and vital prognosis.
The purpose of our observation is to emphasize the value of early diagnosis and the urgent performance of imaging (computed tomography CT).

A 19-year-old patient, who presented 10 days before hes hospitalization, diffuse headache, right periorbital pain preceding the onset of right orbital swelling, all progressing in a feverish context.
Ophthalmological examination:
Visual acuity 8/10 in the right eye; 10/10 in left eye.
In the right eye:
An inflammatory swelling of the upper eyelid, red hot painful and renitant.
The inflammation is spread to the lower eyelid.
Examination of the left eye: normal.
Neurological examination: no sign of localization.
Orbito-cerebral computed tomography:
Right supero-internal intra-orbital abscess extended to the upper eyelid.
Right frontal brain abscess exerting a mass effect.
Biology :
An inflammatory syndrome.
A puncture evacuating the eyelid abscess (was sterile).
The patient was hospitalized in the neurosurgery department for additional management: the evolution was satisfactory.
Orbital cellulitis = common cause of acute inflammation of the orbit.
The infectious invasion of the orbit is either hematogenous (sepsis) or by contiguity.
In contiguous orbital invasion, the sinus origin is involved in at least two-thirds of orbital cellulitis in adults and in 90% of cellulitis in children.
Its development is unpredictable. It can lead to local complications (subperiosteal abscess, intraorbital abscess, optic neuritis and atrophy, blindness), intracranial (brain abscess, sub and extradural empyema, cavernous sinus thrombosis) and sometimes death.
Computed tomography allows an accurate assessment of intra-orbital, bone and sinus lesions and intracranial complications.
Treatment is medical with adequate antibiotic therapy; surgery is only necessary in case of abscess or intracranial suppurative collection.
The prognosis is generally favorable for rapid and appropriate treatment.
Orbital cellulitis = diagnostic and therapeutic emergency.
It is important that it is recognized early and treated vigorously.
It is always a possible cause of blindness, even of death in the event of complication (s).
Orbito-cerebral computed tomography is an essential diagnostic test.
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P231
METHANOL INDUCED TOXIC OPTIC NEUROPATHY: CASE REPORT
Salma El Moataz Billah
Miscellaneous
Salma

EL MOATAZ BILLAH
Morocco
Methanol intoxication may occur as a result of accidental consumption of methanol-contaminated alcoholic beverages, deliberate or accidental ingestion of methanol containing products and rarely inhalation of methanol fumes in chemical industries or inhalation abuse. Methanol poisoning may lead to severe complication such as severe visual dysfunction, metabolic disturbances, permanent neurological dysfunction and even death. Permanent loss of vision from methanol intoxication has been observed in another 20-40% of patients who survive the acute injury.
Ophtalmology departement, 20 Aout 1953 university hospital of Csablanca, Morocco.
We report the case of an inhalation abuse of methanol leading to toxic optic neuropathy, inhalation being an uncommon route of intoxication.
A 35-year-old male patient presented to the ophthalmology emergency department with 10 days history of fatigue, headache and progressive, painless lbilateral vision loss after inhaling a rag soaked with carburetor cleaner . He had a history of chronic solvent abuse for four years, alcohol ingestion, and tabagism .The neurological evaluation including motor, sensory, and cerebellar system examination showed generalized hyperreflexia and severe reduction of the direct and consensual photo motor reflex responses.
On examination, visual acuity was light perception in both eye with bilateral mydriasis. The anterior segment evaluation showed no abnormalities. Stage three papilledema in both eyes was revealed by fundoscopy. Magnetic resonance imaging showed bilateral symmetric T2 signal hyperintensity with contrast enhancement of the optic nerves .
The diagnosis of methanol poisoning was made on the basis of methanol inhalation abuse, metabolic acidosis, visual dysfunction and MRI findings. The non-availability of standardized protocol and equipments made it impossible to check the methanol blood level.
Intravenous methylprednisolone 1g once-daily was administered for 3 days continued with oral prednisone at 1 mg/kg along vasodilation drugs. After 6 weeks of treatement, there was no functional improvement. The patient was enrolled in a inhalant-specific treatment programs for detoxification.
Clinicians need to thoroughly question patients, regarding their possible toxic habitudes while investigating cases of optic neuritis. The early use of intravenous steroids may have promising results while managing toxic optic neuritis.
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P232
VOGT-KOYANAGI HARADA SYNDROME IN ITS PURELY OCULAR FORM: ABOUT A CASE
Najoua El Moubarik
Miscellaneous
Najoua

EL MOUBARIK
Morocco
presenting a rare case of vogt-koyanagi Harada syndrome in its purely ocular form
Ophthalmology A department, Ibn Sina hospital, Rabat, Morocco
We report the case of a 19-year-old man, with no particular pathological or traumatic history, presenting a sudden and bilateral decrease in visual acuity estimated at 20/200 in both eyes. Anterior segment evaluation revealed corneal endothelial pigment deposition in both eyes. Posterior segment examination revealed serous retinal detachments in both eyes with a hyalitis and grade I papilledema
Imaging with spectral-domain OCT (SD-OCT) showed multiple extensive serous retinal detachments in both eyes. Fluorescein angiography revealed multifocal pinpoint leakage in the posterior pole in both eyes. The biological, infectious and immunological assessment carried out returned to normal. The diagnosis of VKH syndrome in its purely ocular form was retained. Methylprednisolone bolus corticosteroid therapy of 1 g / day for 3 days with oral relay of 1 mg/kg/ day of prednisone substituted in the third month by treatment with azathioprine. The course was marked by almost complete functional recovery in 2 months with disappearance of serous retinal detachment on angiography and persistence of a few hyperfluorescent areas corresponding to pigmentation disorder of the pigment epithelium.
VKH syndrome in its so-called possible form is rare, but the diagnosis must be made in view of the characteristic features on the fundus and on angiography with a view to early treatment on the basis of a good prognosis
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P233
TUBERCULOSIS REVEALED BY OCCLUSIVE RETINAL VENOUS VASCULITIS: A CASE REPORT
Sara Elhachimi
Miscellaneous
Sara

elhachimi
Morocco
The aim of this work is to provide an update on this poorly known and sometimes under-diagnosed pathology due to its rarity.
adult ophthalmology department, hospital 20 aout, casablanca, morocco
She is a 40 years old woman, immunocompetent, well vaccinated, without any particular history, Consulted urgently for a decrease in visual acuity for distance and near rapidly progressive in a few days, at the examination: a collapsed visual acuity in bilateral, the anterior segment is without particularities, at the bottom of the eye we objective a pre-retinal hemorrhage of the right eye and intravitreal hemorrhage of the left eye.
At the retinal angiography, a retinal vasculitis with a fibro-vascular veil was observed in the right eye and a vaso-occlusive vasculitis was observed in the left eye, at the etiological check-up, a positive IDR with tuberculin was observed, the quantiferon dosage was normal: The thoracic-abdominopelvic scan was normal (no parenchymal lesions or adenopathy), an etiological search ruled out Behçet's disease, sarcoidosis, syphilis and borreliosis, which allowed us to retain the diagnosis of tuberculous occlusive periphlebitis without systemic infection.
Ocular tuberculosis remains a rare entity in immunocompetent patients, but it should be evoked in the presence of an isolated inflammation of the ocular tissues. The diagnosis is most often based on a combination of clinical, biological and radiological evidence.
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P234
EPLERENONE IN THE TREATMENT OF CENTRAL SEROUS CHORIORETINOPATHY
Ismail Essamlali
Miscellaneous
Ismail

essamlali
Morocco
Central serous chorioretinitis is a relatively common eye condition. It is a maculopathy of the young subject, characterized by the presence of a retinal serous detachment (DSR) usually located at the posterior pole, associated with changes in the pigment epithelium it is characterized by a vanishing point causing sub-retinal fluid accumulation.
We report a case of a patient with chronic central serous chorioretinitis evolving for about three months , who has positively responded to a medication
Eprenolone 25 mg was given per day the first week, then 50 mg per day for an average treatment duration of 12 weeks) . The patient was seen a month later, with visual acuity recovery from 3/10 to 10/10, with improvement in macular syndrome
CRSC is a rare complication of systemic corticosteroid therapy, several cases of corticosteroid-induced CRSC were found in the literature , It has been suggested that CRSC may result from hyperactivation of mineralocorticoid receptors in choroidal vessels, and thus it has been hypothesized that mineralocorticoid receptor antagonists may be a treatment for CRSC
Different studies where conducted to show the effect of eprenolone in this pathology , a dose of 25–50 mg/day has been found to be effective and well-tolerated for the treatment of chronic CSCR. Treatment with mineralocorticoid receptor antagonists appears to be a promising therapeutic option
CSCR is a challenging disease to understand and treat, since its pathogenesis remains elusive and multifactorial. Pharmacologic approaches, like eplerenone, are intriguing, as they target several pathophysiological pathways and may lead to visual acuity improvement and more rapid recovery.
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P235
PILOCARPINE INDUCED ACUTE ANGLE CLOSURE GLAUCOMA
Abbas Fahem
Miscellaneous
Abbas

Fahem
United Kingdom
To highlight the paradoxical effect of pilocarpine as a potential trigger for acute angle closure glaucoma when used in patients with secondary angle closure glaucoma.
85 year old presented to the eye casualty with acute pain, redness, blurred vision and raised intraocular pressure of 60mmHg in his right eye two days after he had been started on pilocarpine to control his intraocular pressure. He has 3 year history of secondary angle closure glaucoma developed after implantation of secondary sulcoflex toric IOL for residual astigmatism following a routine cataract surgery. Examination showed corneal haziness, raiased IOP of 60 and 360 angle closure with iris bombe and PAS. IOP normalised after administering intravenous acetazolamide and then IV mannitol followed by YAG peripheral iridotomy 24 hours later. The fellow eye is pseudophakic with wide open angle and normal IOP.
This is a case report of what we think a rare cause for inducing an acute angle closure glaucoma in a pseudophakic patient. Acute rise in IOP with shallowing of the anterior chamber can be due to several causes depending on the lens status, past ocular history, past medical and drug history. In this case, as patient is pseudophakic, the most important differential was secondary acute angle closure glaucoma and aqueous misdirection. As the patient has had no peripheral iridotomy on presentation and the fact that anterior chamber has widened after performing YAG PI, secondary acute angle closure glaucoma induced by pilocarpine use was the most likely explanation.
Pilocarpine is a muscarinic agonist that can lower the IOP by inducing miosis which pulls the iris away increasing the angle width and also by inducing ciliary body contraction that stretch the trabecular meshwork and Schlemm canal thereby increasing aqueous outflow. However, ciliary body contraction can also induce forward movement of iris-lens diaphragm which can lead to pupillary block and subsequent angle closure. In this case, the pupillary block was further potentiated by the presence of the secondary sulcus toric IOL.
Whilst pilocarpine is a well-established treatment for various types of glaucoma especially in acute angle closure situation or as pre-laser treatment. It can itself causes paradoxical pupillary block glaucoma. Therefore, it should be used in caution especially in patients with secondary angle closure glaucoma.
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P236
IMPACT OF GLAUCOMA EYEDROPS ON OCULAR SURFACE AND MEIBOMIAN GLAND FUNCTION
Filipe Gouveia-Moraes
Miscellaneous
Filipe

Gouveia-Moraes
Portugal
Glaucoma is a chronic and progressive disease where intraocular pressure (IOP) is the only modifiable risk factor. Previous studies reported that long-term use of glaucoma drops leads to ocular surface disease which compromises treatment compliance and outcomes of filtration surgery. Ocular surface damage can be accessed with tests like TBUT and corneal staining however they can be normal in early disease. Corneal epithelial thickness (CET) can provide information of ocular surface disease even in early stages, and it can be access by using anterior segment optical coherence tomography (AS-OCT). Also important in ocular surface evaluation is the meibomian gland function, accessed by lipid layer thickness (LLT). Taken it into account we aim to access the impact of long-term use of anti-glaucomatous drops on ocular surface integrity and meibomian gland function.
Hospital Garcia de Orta
Cross-sectional observational case series including glaucoma patients treated with lowering pressure eye drops for at least 12 months. Duration of therapy, number of drugs, active principle and preservative presence were noted. Controls comprised healthy patients. Dry eye disease (DED) diagnostic criteria included symptoms by OSDI questionnaire and signs (TBUT and corneal fluorescein score (CFS). LLT was accessed by interferometry with LipiView® interferometer. CET was measured with AS-OCT (Cirrus HD-OCT). Statistical significance was set at p<0.05.
40 patients treated with lowering-IOP drops were included in our study. There was no difference in age between groups (p>0.05). Eyes treated with anti-glaucomatous drops had higher proportion of DED diagnosis, with higher OSDI and CFS scores and lower TBUT (p=0.03). LLT was lower in treated patients (p=0,02). LLT was inversely correlated with number of glaucoma drops, but the difference was not statistically significant. The central CET was lower in treated patients. Patients treated with preservative-containing topical medications had lowest CET (p=0.03).
Glaucoma drops negatively affected ocular surface and meibomian gland function. Lubricant drops with lipid composition should be added to glaucoma therapy to minimize dry eye signs and symptoms in these patients. Preservative-free drops might be a preferable treatment option to decrease glaucoma eyedrops impact in ocular surface.
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P237
CHOROIDAL TUBERCULOMA: THE ONLY REVEALING SIGN OF ISOLATED OCULAR TUBERCULOSIS IN AN IMMUNOCOMPETENT CHILD
Asmae Guechati
Miscellaneous
Asmae

Guechati
Morocco
Ocular tuberculosis can manifest itself in different forms, including choroidal tuberculoma, a rather rare form with little expressive symptoms.
Choroidal tuberculoma is a rare form of ocular tuberculosis, presenting less frequently in patients without evidence of systemic disease.
The diagnosis of choroidal tuberculoma is facilitated by several paraclinical examinations, in particular optical coherence tomography, which shows the fusion of the retinal pigment epithelium (RPE) layer with the neurosensory retina on the granuloma, defining the'contact sign'
The retinal angiography, as for it, makes it possible to highlight the presence of hypo fluorescent lesions at the early time which, at the late time, become hyper fluorescent.
At the same time, angiography also plays an important role in eliminating differential diagnosis. These include choroidal hemangiomas, foreign bodies, melanomas and secondary metastatic tumors.
Thus, neuroretinitis due to tuberculosis should rule out other etiologies such as bartonellosis, syphilis, Lyme disease, toxoplasmosis and sarcoidosis.
Treatment is based on first-line antibacillary drugs for 6 to 12 months combined with systemic corticosteroids. Systemic corticosteroids have been shown to have potential for reducing inflammation in ocular tuberculosis.
The case of an 11 year old child is presented, with no notable pathological history, who has been suffering from myodesopsia of the right eye for 10 days
The visual acuity was 10/10th with normal examination of the appendages and the anterior segment bilaterally. The fundus was unremarkable in the left eye but showed a yellowish choroidal lesion in the inferior temporal region with exudates forming a macular star in the right eye.
The patient underwent an optical coherence tomography which revealed a homogeneous and hypo-reflective choroidal lesion in the shape of a dome leading to an elevation of the hyper-reflective retina with discontinuity of the retinal pigmentary epithelium.
Angiography showed a small area of hypofluorescence in the early phase, retaining fluorescein in the late phase.
An intradermal tuberculin reaction with quantiferon was performed and came back positive.
The search for koch's bacilli (BK) in the sputum was negative as well as the different serologies.
Radiologically, the chest X-ray was normal, completed by a CT scan of the cervix, thorax, abdomen and pelvis (CTAP), showing adenomegaly on the upper and lower diaphragm.
The patient also underwent an optical resonance imaging (MRI) of the cerebro-orbital region which came back without any abnormalities.
On this, the child was put on antibacillary drugs for a period of 6 months which could be prolonged, with a general corticosteroid therapy..
The diagnosis of tuberculosis remains a challenge, particularly in ocular tuberculosis, based on a combination of clinical and paraclinical evidence.
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P238
VISION OF AMBLYOPIC ADULT PATIENTS AFTER CLEAR LENS EXTRACTION.
Juraj Halicka
Miscellaneous
Juraj

Halicka
Slovakia
To find out long term change in vsual acuity after clear lens extraction (CLE).
Retrospective study of adult patients with amblyopia after CLE.
Total 34 patients with amblyopia of various degrees underwent CLE in the period from 2013 to 2020. After excluding other eye diseases, we evaluated 23 patients aged 39-59 years, of which 18 were women and 5 men. In all cases multifocal intraocular lenses were implanted. Total 15 eyes were analyzed in patients with anisometropic amblyopia and 8 eyes in patients with strabismic amblyopia. Change in visual acuity were evaluated 1 month and 1 year after surgery. Paired, non-paired T-test and Mann-Whitney test were used for statistical analysis where appropriate.
The results for the group of anisometropic amblyopes were as follows: UCDVA before OV and 1R after 0.13 ± 0.09 vs. 0.57 ± 0.27 (p<0.05); BCDVA before operation (OP) and 1R after 0.51 ± 0.23 vs. 0.62 ± 0.3 (p> 0.05); UCNVA before OP and 1R after 0.08 ± 0.06 vs. 0.47 ± 0.31 (p<0.05); BCNVA before OP and 1R after 0.57 ± 0.14 vs. 0.53 ± 0.31 (p> 0.05). The results were as follows for the group of strabismic amblyopes: UCDVA before OP and 1R after 0.12 ± 0.09 vs. 0.66 ± 0.34 (p<0.05); BCDVA before OP and 1R after 0.54 ± 0.21 vs. 0.69 ± 0.33 (p> 0.05); UCNVA before OP and 1R after 0.05 ± 0.05 vs. 0.50 ± 0.37 (p<0.05); BCNVA before OP and 1R after 0.51 ± 0.28 vs. 0.57 ± 0.42 (p> 0.05).
Our small study shows that the use of multifocal IOL in CLE is effective in patients with amblyopia, we did not observed any serious side effects. BCDVA and BCNVA 1 year after refraction correction did not changed in amblyopic eyes.
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P239
SEVERE INFECTIOUS KERATITIS REVEALING AN HIV INFECTION IN A 2 MONTHS OLD INFANT
Hind Hamdani
Miscellaneous
Hind

Hamdani
Morocco
Infectious keratitis is a medical emergency.
We report the case of a retroviral infection revealed by a corneal abscess and the importance of the general examination of the infant.
Pediatric ophtalmology department, Hopital 20 Août 1953 Casablanca Morocco
We report the case of a 2 month old infant who was treated for an acute intussusception and who presented with a red right eye 3 days prior to his consultation.

Ophthalmological examination of the infant revealed a red right eye with purulent secretions and a subtotal corneal abscess complicated by descemetocele.
Examination of the contralateral eye was unremarkable.
A corneal sampling with removal of the fibrin was performed under sedation, and a treatment based on vancomycin and ceftazidime fortified eye drops was started with a local hypotensive drops. When the patient did not improve, fluconazole-based antifungal eye drops were introduced 48 hours later.
Bacteriological, parasitological and fungal results were negative.
The patient presented respiratory distress 5 days after hospitalisation and was transferred to the intensive care unit. A Covid-19 infection was ruled out, as well as cardiac pathology. In view of the non-improvement and the onset of a fever of 39°C, an immune check-up was carried out, revealing an HIV infection.
An antiviral treatment was started but unfortunately the evolution resulted in the death of the patient.
Translated with www.DeepL.com/Translator (free version)
Ophthalmological examination of the infant revealed a red right eye with purulent secretions and a subtotal corneal abscess complicated by descemetocele. Examination of the contralateral eye was unremarkable. A corneal sampling with removal of the fibrin was performed under sedation, and a treatment based on vancomycin and ceftazidime fortified eye drops was started with a local hypotonant. When the patient did not improve, fluconazole-based antifungal eye drops were introduced 48 hours later. Bacteriological, parasitological and fungal results were negative. The patient presented respiratory distress 5 days after hospitalisation and was transferred to the intensive care unit. A Covid-19 infection was ruled out, as well as cardiac pathology. In view of the non-improvement and the onset of a fever of 39°C, an immune check-up was carried out, revealing an HIV infection. An antiviral treatment was started but unfortunately the evolution resulted in the death of the patient.

Infectious keratitis is a major global cause of visual impairment and blindness. In infants it usually complicates a known or unnoticed trauma. However, the general examination of the infant should not be overlooked as other signs may be present that point to an aetiology, as in our case.

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P240
ALL ABOUT RETINAL DETACHMENT: CONTRIBUTION OF ULTRASOUND
Zineb Hammoumi
Miscellaneous
Zineb

HAMMOUMI
Morocco
The aim of our study is to specify the contribution of ultrasound in the diagnosis of retinal detachments and in the follow-up of patients.
Pediatric ophtalmology department. Hospital 20 august 1953. Casablanca. Morocco.
Prospective study of 60 cases of retinal detachment collected in the Ophthalmology and Radiology Department of the August 20 Hospital of the Ibn Rochd University Hospital of Casablanca – Morocco, over a period of 6 months (December 2020-June 2021). 60 patients underwent ocular ultrasound with a 12 Mhz high frequency linear probe.
The age of the patients varies between 4 and 80 years with a male predominance (40 men for 20 women); that is to say a sex ratio of 2. The reason for consultation is dominated by the sudden drop in visual acuity and ocular trauma. The etiologies were diverse, dominated by diabetic tractional detachment and post-traumatic detachment. Ultrasound revealed 53 total retinal detachments and 17 partial detachments. Pathologies associated with the detachment were dominated by cataract and intravitreal hemorrhage. Ultrasound examination allowed the diagnosis of detachment before the clinic in cases where exploration of the posterior segment was impossible.
Ocular ultrasound is an essential examination in the diagnosis of retinal detachment, particularly in cases of impure anterior and/or posterior segment. It is a simple examination to perform, which must be requested without delay for rapid management of patients.
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P241
LENTICONUS ANTERIOR AND LENTICONUS POSTERIOR : RARE OCULAR MANIFESTATIONS: 2 CASE REPORTS
Soukaina Homaide
Miscellaneous
Soukaina

HOMAIDE
Morocco
Lenticonus is a bulging of the lens capsule and the underlying cortex. The diagnosis of lenticonus is essentially a clinical diagnosis which is made by biomicroscopic examination. According to the localization of the conus a distinction is made between lenticonus anterior and lenticonus posterior.
A case report of two patients, the first one suffering from lenticonus anterior associated with Alport's syndrome and the second one from lenticonus posterior without any systemic manifestations.
Case 1 : A 24‑year‑old male, with Alport syndrome presented for progressive loss of vision in both eyes , On ocular examination, his best corrected visual acuity was 04/10 on the right eye, and 2/10 on the left eye. Refraction showed high myopia -15.50 (-2.00 à 50) in the right eye and -17.25 (-2.25à140°) in the left eye. Slit lamp examination revealed conical protrusion of anterior surface of crystalline lens suggestive of anterior lenticonus in both eyes. Fundus was normal. Clear lens extraction operation was proposed but the patient refused the surgery.
Case 2 : A 30-year-old female, with no medical history, presented for history of poor vision, eye examination revealed her best corrected visual acuity was 02/10 on the right eye, and 10/10 on the left eye. Refraction showed -3,5D (-4,00 à 50°) in the right eye and (-0,50 à 50°). Slit lamp examination revealed a posterior protrusion of the lens, extending towards the vitreous chamber The rest of the eye examination was unremarkable.
Lenticonus anterior was first described by Webster (1874). It is characterised by a regular, welldefined conical or more globular protrusion of the anterior part of the lens into the chamber. Catarct often occurs together with lenticonus anterior.The cause of lenticonus anterior is unknown. Theories are numerous. Amongst the most important can be mentioned : Development abnormality, a toxic metabolite, inflammation, and trauma. Posterior lenticonus is a circumscribed round or oval bulge of the posterior lens capsule and cortex . It is a rare condition and had been known since described by Meyer in 1888. It may usually presents as the only ocular anomaly and generally unilateral or it may be bilateral .The pathogenesis of the anomaly is mainly due to inherited thinning and weakness of the central part of the posterior lens capsule, visual loss may be secondary to the development of the cataractous changes or to The high refractive errors, mostly myopic.
We concluded from the clinical study of these two cases and from reviewing the reported cases in the literature that ophthalmologists should be careful in examining patients with Alport syndrome and should remain alerted to the possibility of the presence of posterior lenticonus or the potential of anterior lenticonus to progress into posterior lenticonus.
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P242
EPIDERMOID CONJUNCTIVE CARCINOMA : ABOUT 16 CASES
Hasnaoui Ihssan
Miscellaneous
Hasnaoui

ihssan
Morocco
Malignant tumors are much rarer, but should always be present in the mind of the ophthalmologist. The most represented is conjunctival squamous cell carcinoma (CEC) which is one of the differentiated squamous tumors. It is recognized as having a long precancerous course including multiple dysplasias until carcinoma in situ (CIS) which progresses slowly.
ophtalmology B Departement ,speiality hospital of ibn sina ,Rabat ,Morocco .
We report a retrospective study conducted at the Ophthalmology B service in Rabat, involving 16 cases collected between June 2019 and December 2020. Our patients presented with conjunctival and / or corneal lesions. Treatment consisted of carcinological tumor excision supported by data from pathological examinations.
The average age of our patients is 62.7 years, apart from the children followed for Xeroderma pigmentosum whose average age is 11 years with extremes of 4 years and 26 years, without sex ratio with an average diagnostic delay of 23 months. The clear phototype represents a constant risk factor in 25% of cases. 2 patients were strongly exposed to the sun in their professional environment having exercised an activity in the open air; 55% of patients are followed for Xeroderma pigmentosum.
Slit lamp Examination of the patients found localized polymorphic tumor, corneal and conjunctival lesions. The anatomopathological study after incisional biopsy revealed squamous cell carcinoma in situ in 4 patients and invasive squamous cell carcinoma in the remainder. The treatment was conservative surgery in 13 patients associated with topical chemotherapy based on mitomycin C either adjuvant or neoadjuvant, 3 patients underwent total orbital exenteration following a locoregional invasion. The patients are regularly followed in our training only one case of limbic insufficiency following local chemotherapy was observed, 2 patients presented a local recurrence, no patient died of his disease during the observation period.
A biopsy-excision of any suspicious lesion is the best way to confirm the diagnosis. As well as the systematic analysis of pterygium excisional parts makes it possible not to ignore conjunctival neoplasia, of which we know the variability of the initial clinical pictures. The early diagnosis improves the prognosis.
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P243
RETINOBLASTOMA: RETROSPECTIVE STUDY OF 18 CASES .
Hasnaoui Ihssan
Miscellaneous
Hasnaoui

ihssan
Morocco
Retinoblastoma is a malignant intraocular tumor affecting mainly infants and children especially under 5 years old. It is a disease involving both the functional and the vital prognosis. The involvement is either unilateral or bialteral. The diagnosis of retinoblastoma is essentially clinical and is currently being improved following developments in medical imaging and its contribution. Its management is multidisciplinary and requires urgent intervention in a specialized environment. The therapeutic aspect has progressed in recent years.We report through our study the epidemiological and clinical aspect of retinoblastoma and we discuss its therapeutic management .
ophtalmology B Departement , Speciality hospital of ibn sina ,Rabat ,Morocco .
It's a retrospective study , a series of 18 patients collected in the ophtalmology B departments at the hospital of specialities in Rabat between January 2018 and september 2021.
In our study the average incidence corresponded to 4.5 cases per year, the average age of diagnosis was 26 months with a clear male predominance (75%), the notion of consanguinity was reported in 20.7% cases. A history of a monophtalmic father and brother who died from retinoblastoma was reported in a single patient . The disease was unilateral in 88.88% of cases and bilateral in 11.11% of cases. The most frequent reason for consultation was leukocoria associated with other symptoms (41%), followed by strabismus (11%) and exophtalmos (11%). The diagnosis was made after ophtalmologic examination under general anesthesia combined with the radiologic data. The endophytic form of retinoblastoma represented 76.74% of cases; however 23.25% corresponded to exophytic forms. The optic nerve invasion in 5.5% of cases, and choroid in 35.29% of cases, Therapeutically, In all admitted patients, neoadjuvant chemotherapy was performed , enucleation was necessary in most cases (96.01%), The thermo-chemotherapy in 2 patients with bilateral retinoblastoma. Follow-up varie between 2months and 48months; Exposure of the ball was noted in 1 patient and only one case of death in a patient who had bilateral retinoblastoma despite an enuclation of the 2nd eye and adjuvant radiochimiotherapy .
The management of retinoblastoma is multidisciplinary and must be as early as possible, it involves surgery, chemotherapy, which has evolved a lot in recent years, radiotherapy and especially focal therapies such as thermotherapy, thermo-chemotherapy, cryotherapy , brachytherapy, and gene therapy. The goal of the therapist is therefore the survival of the patient, the preservation of his visual function, and the improvement of the aesthetic appearance by the placement of an ocular prosthesis in the operated patients.
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P244
DOES OPHTHALMOLOGY TRAINING MATCH STUDENT EXPECTATIONS? – A UK NATIONAL SURVEY
Imran Janmohamed
Miscellaneous
Imran
Karim
JANMOHAMED
United Kingdom
To evaluate the perceptions of a career in ophthalmology among medical students and compare this with the reality experienced by current specialty trainees.
United Kingdom medical schools and specialty deaneries.
This study was conducted in two parts. We first contacted medical students from 31 medical schools to participate. 14 ophthalmology societies at these universities consented to distribute our questionnaire. We then distributed a separate survey to UK ophthalmologists through social media and professional networking groups to explore how their perceptions changed before and after obtaining a specialty post. Responses were collected over eight weeks after two rounds of local advertising and we compared these results.
We received 72 responses from our student survey. 45.8% said that they were 'somewhat likely,' to apply for ophthalmology training in the future, while 25% responded with 'very likely'. The main factor which sparked an initial interest in ophthalmology was a good experience during ophthalmology placements. The ophthalmologist survey yielded 7 responses from 7 different training regions, with varying levels of experience, from their first (ST1) to last (ST6) year of specialty training. Regarding specialty applications, the main perceived expectation from students was being well published. However, only one trainee also reported this as an expectation from prospective ophthalmology trainees. Instead, m0st encouraged attempting a fellowship exam and evidence of commitment and exposure to the specialty. Furthermore, in line with student perceptions, many (42.9%) trainees had engaged in specialty-related extra-curricular activities whilst at university. Regarding motivating factors to pursue ophthalmology, career flexibility and intellectual stimulation were the most important factors influencing students to pursue ophthalmology, whilst competitiveness of the specialty application was by far the main deterrent. However, in retrospect, doctors reported the work-life balance was not as flexible as expected, and that competitiveness continued post-specialty application as well. Encouragingly, 85.7% of trainees reported that they were 'very satisfied' with their decision to pursue ophthalmology.
This study compared medical students' perceptions to those of current trainees of ophthalmology as a career. Factors such as career flexibility and intellectual stimulation were important motivating factors guiding choice for specialty applications. However, it is vital that students gain a realistic expectation of ophthalmology as a career: current trainees conveyed that certain aspects, such as flexibility and even components of the application were not in line with their prior perceptions. We suggest students to take advantage of taster sessions at their local institutions, and for universities to facilitate more exposure to the spectrum of specialties and their realistic advantages and drawbacks.
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P246
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PARKINSON’S DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Andreas Katsimpris
Miscellaneous
Andreas

Katsimpris
Greece
We performed a systematic review and meta-analysis of the literature up to date and summarized eligible studies on the differences of optical coherence tomography angiography (OCTA) retinal measurements in Parkinson's disease (PD) patients and controls and performed bias analysis to assess the robustness of the association estimates to unobserved confounding.
We performed a literature search for eligible studies on MEDLINE and EMBASE from database inception up to October 13,2021 and adopted a two-step screening process.
We used the Hartung-Knapp-Sidik-Jonkman random-effects method (1) to combine study-specific SMD in pooled effect estimates and a meta-analytic extension of the E-value metric (2) to quantify the confounding bias capable of nullifying the pooled estimates.
We identified nine eligible cross-sectional studies, involving 475 eyes from PD patients and 781 eyes from healthy controls. The pooled standardized mean differences (SMD) of retinal vessels density (VD) in the whole superficial vascular plexus (SVP), foveal SVP, parafoveal SVP and foveal avascular zone (FAZ) was -0.57 [95% CI: -1.08 to -0.05, p-value=0.04], -0.14 [95% CI: -0.88 to 0.59, p-value=0.62], -0.59 [95% CI: -1.41 to 0.23, p-value=0.12] and -0.20 [95% CI: -0.79 to 0.38, p-value=0.39], respectively. In order for the SMDs estimates of VD in whole SVP, foveal SVP, parafoveal SVP and FAZ to be nullified, an unmeasured confounder would have to be associated with a risk ratio of 2.74, 1.54, 2.81 and 1.70, respectively, with the risk of PD or the corresponding OCTA measures.
Our results support associations between OCTA retinal measurements and PD, suggesting that OCTA may be a potential useful tool in the diagnosis of PD.
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P247
COMPARISON OF THREE DIFFERENT INTRAOCULAR PRESSURE MEASUREMENT METHODS IN DIFFERENT TYPES OF GLAUCOMA
Ilgin Kaya
Miscellaneous
Ilgin

KAYA
Turkey
Comparison of intraocular pressure (IOP) values measured by non-contact tonometry (NCT [Topcon®, Japan]), Corvis ST® (CST [Oculus®, Germany]) and Goldmann applanation tonometry (GAT) in cases with glaucoma.
Cross-sectional study
In this cross-sectional study, cases with primary open-angle glaucoma (POAG), pseudoexfoliative glaucoma (PEG) and pigmentary glaucoma (PG) and healthy volunteers as control group were included. IOP values were measured with CST, NCT and GAT in all cases. Central corneal thickness (CCT) was measured with Corvis ST. The correlation between IOP measurement methods and the relationship of this correlation with glaucoma type and demographic/clinical variables were examined.
Ninety-two eyes of 48 glaucoma patients (29 males, 19 females) with a mean age of 61.1±11.5 years and 55 eyes of 55 volunteers with a mean age of 44.9±9.6 years were included in the study. Twenty-five patients were being followed up with the diagnosis of POAG, 15 patients with PEG, and 8 patients with PG. There was no significant difference between glaucoma and control groups in terms of CCT values (mean 530.2±31.3 micron, 542.1±30 micron, respectively; p=0.114). Mean IOP values in the glaucoma group were 17.9±4.0 mmHg with NCT, 14.9±4.1 mmHg with GAT, and 17.4±8.1 mmHg with CST (p<0,001). In the POAG cases, GAT and CST (correlation coefficient [cc]=0.851, p<0,001), in the PEG and PG cases GAT and NCT (cc =0.876, p<0.001; cc=0.746, p=0.001, respectively), and in the control group NCT and CST (cc=0.591, p<0.001) measurements showed the strongest correlation. CCT was correlated with NCT in the POAG group (cc:0.306, p=0.037), with CST in the PEG group (cc=0.445, p=0.018), with GAT in the PG group (cc=0.719, p=0.002) and with NCT in the control group (cc =0.254, p=0.075).
The correlation between GAT, which is the gold standard method for measuring intraocular pressure, and other intraocular pressure measurement methods may differ depending on the type of glaucoma. In our study, the most consistent measurements with GAT were obtained with CST in patients with POAG and with NCT in other glaucoma types. The relationship between CCT and IOP measurements may vary depending on the measurement method and glaucoma type.
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P248
POST-TRAUMATIC RUPTURE OF BRUCH'S MEMBRANE : A CASE REPORT
El Hamraoui Kenza
Miscellaneous
El
HAMRAOUI
KENZA
Morocco
Ocular trauma is a major public health problem. All ocular structures can be damaged in case of a closed globe injury. These lesions, often multiple, can appear immediately or in a delayed manner. Choroidal rupture involves the choroid, Bruch's membrane, and the retinal pigment epithelium.
To report a case of post-traumatic rupture of Bruch's membrane through a medical observation.
A case of post traumatic rupture of bruch's membrane in a 27 year old patient seen in our department
This is a 27-year-old man with no previous pathological history who suffered a contusive trauma to the left eye by a punch following a fight one hour before his admission to the emergency room.
The initial examination revealed a conscious patient in good general condition with significant palpebral edema and an inability to open the eyeball. The patient was treated with corticosteroids at a rate of 1mg/kg/d for 48 hours and was seen again after edema had subsided. Examination at 48 hours revealed hand movement visual acuity in the left eye, slight residual palpebral edema, an unremarkable anterior segment, and subretinal hemorrhage in the fundus with suspicion of Berlin edema in the macular region. The examination of the adelphic eye was unremarkable with a visual acuity of 10/10. Fluorescein angiography showed pre-retinal and sub-retinal macular hemorrhages, a large area of ischemia in the macular area, and a spontaneous linear hypofluorescence in the sub-papillary and macular area. Optical coherence tomography of the left eye showed multiple ruptures of Bruch's membrane with the clear involvement of the foveolar depression. The patient was put on anti-inflammatory treatment: oral corticosteroid therapy 1mg/kg/d for 5 days and ketorolac-trometamol collyrium 1 drop 4 times a day for 21 days. The evolution was marked by the resorption of the hemorrhage with the persistence of the areas of ischemia and the rupture of Bruch's membrane. The patient is still followed up in consultation to date to watch for the occurrence of retinal neovessels.
Bruch's membrane rupture is a common complication of contusive ocular trauma. Monitoring should be continued for one year after the incident to detect secondary subretinal neovascularization. In addition to the emphasis on the prevention of ocular trauma, improvement in the management of ocular trauma requires better evaluation of the various treatments available to arrive at a less'empirical' and more appropriate approach.
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P249
EXOPHTHALMOS REVEALING AN INFLAMMATORY PSEUDOTUMOR : A CASE REPORT
El Hamraoui Kenza
Miscellaneous
El
HAMRAOUI
KENZA
Morocco
Idiopathic orbital inflammation syndrome, better known as inflammatory pseudotumor, corresponds to any intra-orbital expansive process of inflammatory type, histologically characterized by non-specific inflammation of the orbit, with no local or systemic cause found. The differential diagnosis is essential with malignant tumor causes dominated in adults by lymphoproliferative syndromes and metastases.
To report a case of inflammatory pseudotumor in a 25-year-old female who responded favorably to corticosteroid treatment.
A case of inflammatory pseudotumor revealed by exophthalmos in a 25 year old patient seen in our department
This is a 25-year-old female patient with no previous history of inflammatory pseudotumor who presented with a right unilateral inflammatory exophthalmos of progressive onset for the past 15 days, complicated by ocular pain for the past 24 hours, which prompted the consultation.
The ophthalmological examination showed moderate right ptosis with exophthalmos, non-axial, non-pulsatile, without a thrill, slightly painful, with minimal VAD without diplopia, and limited right abduction. The slit-lamp examination did not reveal any surface damage, and a normal fundus with an ocular tone of 18 mmHg. The patient did not report any hemoptysis or haematuria. The rest of the clinical examination did not reveal any signs of extraocular involvement. An MRI was ordered, revealing a thickened, diffuse, and homogeneous aspect of the external rectus muscle with respect for its tendon, infiltration of the lateral extra conical fat, and the right lacrimal gland, all responsible for a grade 3 exophthalmos. The etiological work-up (systemic granulomatosis, vasculitis, Graves' disease) came back normal. Treatment with oral corticosteroids at a dose of 1mg/kg/day, combined with supplementation, was initiated for 1 month. A spectacular response was observed, allowing the diagnosis of a non-specific pseudotumor to be made. The evolution was favorable without relapse or complication with a 3-month follow-up.
Inflammatory pseudotumors are a diagnosis of exclusion based on a range of anatomical and clinical or morphological arguments, confirmed in some cases by an orbital biopsy. They remain corticosensitive in the majority of cases.
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P250
NON-CONTACT MEIBOGRAPHY AND NON-INVASIVE TEAR BREAK UP TIME CHANGES WITH REGULAR FACE SHIELD VS FACE MASK WEAR
Reham Fattoh Ahmed Khalil
Miscellaneous
Reham
Fattoh Ahmed
Khalil
Egypt
To determine changes in Meibomian glands and TBUT with prolonged use of face shield versus face mask
Future center for cornea and refractive surgery, Sohag, Egypt
200 eyes of 100 subjects aged 18-40 years were included. Exclusion criteria were refractive or lid surgery, autoimmune diseases and contact lens wearers.
Group A (face shield): 80 eyes of 40 subjects.
Group B (face mask): 120 eyes of 60 subjects.
Duration of wear during the last 6 months: 6 hours or more/day, 4 days or more/week.
Outcomes: Meibograde and meiboscore, NIF-BUT and NIAvg-BUT.
Non-contact meibography and Non-contact BUT
Instrument: sirus ocular topographer.

Group A: Meibograde (14% grade 0, 37% grade1, 29% grade 2, 17% grade 3, 3% grade 4). Average meiboscore was 3.2±0.8. NIF-BUT and NIAvg-BUT were 14±2.4 seconds and 12±3.1 seconds respectively.
Group B: Meibograde (4% grade 0, 19% grade1, 34% grade 2, 28% grade 3, 15% grade 4). Average meiboscore was 5.1±0.6. NIF-BUT and NIAvg-BUT were 8±1.8 seconds and 10±2.1 seconds respectively.
Prolonged face mask wear is associated with MGD compared to face shield.
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P251
CAROTID CAVERNOUS FISTULA- OPHTHALMIC MANIFESTATION OF THE INTERDISCIPLINARY DISEASE. CASE REPORT.
Malgorzata Kozikowska
Miscellaneous
Malgorzata

Kozikowska
Poland
To report a case of a direct carotid-cavernous fistula (CCF) in patient admitted to the hospital over ocular tumor suspicion and to present diagnostic pathway and interdisciplinary approach to treatment of this condition.
Department of Ophthalmology, Medical University Centre of Medical University of Silesia in Katowice.
78-year-old patient was admitted to the hospital over ocular tumor suspicion. She reported exophthalmos of the right eye from 3 months and decreased visual acuity of this eye from 2 months, she denied any head trauma. During admission she presented visual acuity of the right eye 0,1 and of the left eye 0,6 in Snellen charts, IOP RE 27 mmHg, LE 17mmHg. In the right eye we noted pulsating proptosis, conjunctival chemosis and hyperaemia. In fundoscopy we found detachment of choroid in all quadrants and disseminated haemorrhages in the retina. Ultrasound was performed confirming choroidal detachment in all quadrants and revealed hypoechogenic space behind right eyeball. Doppler US showed dilated superior ophthalmic vein (SOV) and increased, arterialised vascular flow. Magnetic resonance of the head and orbit showed exophthalmos of the right eyeball, enlargement of extraocular muscles and dilated right SOV. Because of high suspicion of CCF patient was referred to the Department of Interventional Radiology to perform digital subtraction angiography. This examination confirmed our diagnosis revealing right-sided direct CCF. Due to small size of fistula radiologists and ophthalmologists debated on subsequent treatment however because of the significant ophthalmic symptoms and potential sight loss embolisation of CCF was planned. Procedure was done without complications and partial embolisation was achieved. Unfortunately on the next day patient's general condition deteriorated and MR of head showed ischemic changes of the head of caudatus nucleus, anterior part of internal capsule and lentiform nucleus. Neurological consultation was done and treatment was applied.
Ophthalmic examination was done 2 months after embolisation. Visual acuity of the right eye improved to 0,6, IOP 18 mmHg. We noted only dilated scleral vessels and cataract. No proptosis was seen. However mental condition of patient got worse. She had troubles with memory and had disorientation to the time and place.
Carotid-cavernous fistula is a rare disease however it can be sight-threatening condition and should not be forgotten in our daily practice. Ophthalmologist is usually the first physician to encounter a patient with manifestations of the disease. Decision about treatment should be interdisciplinary and well thought as this procedure carry some complication risk which may exceed sight-threatening risk.
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P252
THINNING OF DONOR GRAFT AFTER CONVENTIONAL DESCEMET’S STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY
Tomislav Kuzman
Miscellaneous
Tomislav

Kuzman
Croatia
Purpose of this study is to evaluate postoperative deturgescence of lamellar donor graft after conventional Descemet's stripping automated endothelial keratoplasty (DSAEK).
All patients were operated and evaluated at Department of ophthalmology, University Hospital Center Zagreb, Croatia.
It was prospective study that included 55 eyes of patients (mean age 70,9 ± 9,4 years; female 61,8%, male 38,2%) who undergone DSAEK keratoplasty. Preoperative thickness of lamella measured by pachimetry in eye bank was compared with postoperative thickness measured with anterior ocular coherence tomography (a-OCT) six months after surgery.
Central lamellar graft thickness decreased from 142 ± 27 µm preoperatively to 124 ± 20 µm 6 months postoperatively (p<0,01). After performing conventional DSAEK corneal transplantation, surgeons should expect deturgescence of corneal graft and reduction in thickness of lamellae about 12% of initial thickness according to our results.

It is important to know value of postoperative thinning of lamellae for better planning of surgical procedures and knowing what to expect after surgery, and also for better cooperation with eye banks when ordering precut corneal tissue.
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P253
ORBITAL METASTASIS OF AN UNDIFFERENTIATED NASOPHARYNGEAL CARCINOMA: A CASE REPORT
Saida Laababsi
Miscellaneous
Saida

Laababsi
Morocco
The aim of this work is to present a case rarely reported in the literature of nasopharyngeal carcinoma (NPC) revealed by an orbital invasion, and is found in a relatively low percentage of patients with orbital tumour.

Adult ophthalmology department, hospital August 20, Casablanca, Morocco.
Patient 58 years old, treated for nasopharyngeal carcinoma 2 years ago, declared in remission, who presents at the consultation for right exophthalmos which worsens with time, with a redness and visual blur evolving since 2 months. The clinical examination finds on the right eye a decrease of the visual acuity (4/10), total ophtalmoplegia and papillary edema at the fundus examination.
A Computed tomography scan (CT scan) of the face was requested which revealed a well-limited oval-shaped right intra-conical tissue process enhanced by contrast injection, invading the optic nerve and oculomotor muscles, coming into contact with the posterior pole of the eyeball, measures 42/30/37.3 mm. A magnetic resonance imaging (MRI) was requested that confirmed the orbital extension of the tumor process. Histopathological examination of the mass found undifferentiated nasopharyngeal carcinoma UCNT (Undifferenciated Carcinoma of Nasopharyngeal Type). The extension assessment was requested and a concomitant chemo-radiotherapy protocol was instituted. The evolution was good with a regression of the intra-orbital tumor mass with a decline of 6 months.
NPC with orbital extension remains a rare entity, but this diagnosis must be considered especially in the presence of ophthalmological signs. Therapeutic protocols must be adapted to each case and take into account the extent of the disease.
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P254
MORNING GLORY SYNDROME: A CASE REPORT
Tabchi Manal
Miscellaneous
Tabchi

Manal
Morocco
morning glory syndrome has a severe functional prognosis because of the amblyopia it causes.
The ophthalmologic involvement may be isolated or associated with a malformative syndrome.
The'morning glory' syndrome is a rare pathology, characterized by a congenital malformation of the optic disc, often accompanied by other malformations, notably cerebral.
We report the case of a 3-year-old female patient, with no notable pathological history, who consulted for a right unilateral divergent strabismus. An ophthalmologic examination with fundus, a refraction under cycloplegic eye drops and an orthoptic assessment were performed. A brain MRI and a pediatric opinion were requested.
The visual acuity was difficult to evaluate, given the age. The fundus examination showed an enlarged papilla, surrounded by a large pigmented ring, with a large excavation. The center of the papilla is occupied by a glial proliferation. The retinal vessels are sparse and radial like a wheel. The macula and the rest of the retina are normal. Automatic refraction revealed myopia with astigmatism. Orthoptic workup was performed with amblyopia treatment. The brain MRI was without abnormalities. And the pediatric examination with cardiac and abdominal ultrasound revealed no associated malformation.

morning glory syndrome is a congenital anomaly of the optic disc, often associated with profound amblyopia. The main complication is retinal detachment, hence the interest of a rigorous surveillance.
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P255
OCT PARAMETERS OF CENTRAL RETINA IN CORONARY ARTERY DISEASE PATIENTS AND CONTROLS
Indrė Matulevičiūtė
Miscellaneous
Indrė

MATULEVIČIŪTĖ
Lithuania
To evaluate the parameters of foveal optical coherence tomography (OCT) in patients with coronary angiography performed.
The study was performed in the university hospital between February of 2019 and October of 2021.
174 participants after initial cardiologic evaluation and coronary angiography were included in the study. According to the indications and the results of coronary angiography, all participants were separated into 3 groups – acute coronary syndrome (ACS, N=76), no changes in coronary angiography (control, N=76) and three vessel disease without previous major coronary events (3VD). All the patients were ophthalmologically examined afterwards. OCT scans of the macula were performed using swept source OCT in addition to standard ophthalmic examination. Retinal and choroidal thickness in ETDRS segments (central, both inner and outer nasal, temporal, superior and inferior ) were calculated automatically by the software. The regional ethical committee of Kaunas approved the research protocol. The tenets of the Declaration of Helsinki were confirmed by the research. The results are expressed as mean and standard deviation. Written informed consent was obtained from participants.
Retinal thickness was statistically significantly greater in control group in comparison to 3VD group in the outer circle of ETDRS segments (286.13;18.189 vs. 275.27;13.228; 262.12;14.932 vs. 253.23;12.386; 273.09;15.492 vs. 264.73;12.646; 263.97;16.112 vs. 253.68;12.785, p<0.05) and in comparison to ACS group in inner temporal (303.26;16.554 vs. 297.29;15.636), superior (313.99;16.580 vs. 309.16;14.569) inferior (311.04;16.815 vs. 305.76;16.864) and outer temporal (262.12;14.932 vs. 255.41;13.547) segments (p<0.05). Comparison of the choroidal thickness values between the groups showed that the choroid of 3VD group was statistically significantly thinner in all ETDRS segments except outer superior segment in comparison to ACS group (p<0.05) and thinner in all ETDRS segments except inner superior segment where 3VD group had thicker choroid in comparison to control group (p<0.05).

The findings of our study suggest that central choroidal and retinal thickness may be important markers of coronary artery disease (the thinning of the retina and choroid is greater with the higher number of coronary arteries affected). The results could be used as a screening tool for coronary artery disease after further research.

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P256
CASE REPORT: PRESERFLO AB-EXTERNO MICROSHUNT IMPLANTATION IN PATIENT WITH ADVANCED GLAUCOMA- IS IT A WAY TO GO?
Anna Mikolajczyk
Miscellaneous
Anna

Mikolajczyk
Poland
To present a report of the attempt to reduce and stabilize intraocular pressure in patient with advanced, glaucomatous optic neuropathy and severe field impairment by implanting Preserflo Ab-Externo Microshunt.
Prof. K. Gibinski University Medical Centre, Department of Ophthalmology, Medical University of Silesia in Katowice, Poland.

A 77-year old woman, hospitalized because of high intraocular pressure in the right eye with advanced neuropathy. By admission, best corrected visual acuity in the right eye was 0,3 and the intraocular pressure was 25 mm Hg on maximal topical therapy. After the thorough assessment and examination, patient had been qualified to the microinvasive glaucoma surgery- implantation of Preserflo Ab- Externo Microshunt in the right eye. The surgical procedure was performed without complications, obtaining the lowering and stabilization of intraocular pressure without IOP- lowering drugs.
The visual acuity in the right eye, while discharged from the hospital, was 0,3. The intraocular pressure in the right eye was stabilized and amounted to 17 mm Hg.
Preserflo seems to be a good therapeutic option also in advanced glaucoma patients with good safety profile. The applied treatment enabled to stabilize the intraocular pressure and retain the previous visual acuity in the rigft eye.
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P257
FOREIGN BODIES IN THE ANTERIOR SEGMENT OF THE EYE
Miroslav Stamenkovic
Miscellaneous
Jovan

Milic
Montenegro
To investigate clinical characteristics and visual outcomes of foreign body in the anterior segment of the eye.
Eye Clinic, University Medical Center Zvezdara, Belgrade, Serbia
Consecutive series of 9 eyes with IOFB located in the anterior segment presented at the Eye Clinic, UniversityMedical Center Zvezdara from 2014 to 2021. Preoperative status and management of injuries were collected retrospectively. The material and location were recorded of all cases.
The average patient age was 48.2 years with male predominance (8 male patients, and 1 female). There were 4 right eyes and 5 left eyes involved. The most frequent injury mechanism was hammering 6 eyes, and the composition of IOFB was metallic in 6 cases . Initial VA was less then 0.1 in 6 eyes , 0.1-0.4 in 1 eye and 0.5 and more in 2 eye. Final BCVA was less then 0.1 in 2 eyes, 0.1-0.4 in 3 eyes and 0,5 and more in 4 eyes. Complications were hypopion in 1 eye, cataract in 8 eyes, vitreous haemorrhage in 2 eyes and hyphaema in 3 eyes.
Initial VA generally is one of the most important prognostic factors for predicting final visual outcome after IOFB in the anterior segment of the eye. Other factors which may predict final vision are size of the wound, location of the wound and the development of complications.
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P258
ORBITAL TUBERCULOSIS : A CASE REPORT
Basma Mrini
Miscellaneous
Basma

mrini
Morocco
We report the case of a 39-year-old patient with a history of tuberculosis contagion 2 years ago and having consulted for swelling of the upper part of the face.
Ophtalmology A department, hospital of speciality of Rabat
The onset of symptoms dates back to 4 months before admission with the onset of periorbital heaviness and pain, then the appearance of swelling in the glabellar region, eyelids and cheeks, then the appearance a few weeks later of multiple fistulas in inner canthi of the eyelids, leaving a slightly lumpy liquid.
The ophthalmologic examination found visual acuity preserved and strictly normal anterior and posterior segments.Computerized tomography (CT) scan of the orbit and head showed a process occupying the frontal and maxillary sinuses, with lysis of the internal wall of the frontal sinuses, the glabellar region, the supero anterior part of the cheeks, pushing the eyeballs out. The eyeballs are unharmed. (Picture 2)Skin biopsy of the glabellar region shows a direct negative bacteriological examination, but histological examination showed a dense inflammatory infiltrate comprising epitheliogigantocellular granulomas with caseous necrosis. The IDR in this patient was strongly positive with accelerated SV. The search for BK in sputum came back negative. The HIV serology was negative.The diagnosis of osteosinus tuberculosis was made due to the history of pulmonary tuberculosis, the presence of fistulas, the result of the histological study, and the strongly positive IDR.The patient was put on antibacillary treatment, according to the protocol: rifampicin (600mg / d), isoniazid (300mg / d), pyrazynamide (1500mg / d), ethambutol (1200mg / d), streptomycin (1g / d) for 2 months , then rifampicin and isoniazid for 10 months, therefore a total duration of 12 months.The outcome was spectacular with almost complete healing clinically and radiologically, but with persistent sinus mucosa hypertrophy, as well as scar-like tissue in the glabellar region.
There is a large clinical polymorphism and tuberculosis should be considered in the presence of unexplained inflammation of the orbit.
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P259
PEDIATRIC CENTRAL RETINAL ARTERY OCCLUSION
Ioanna Mylona
Miscellaneous
Ioanna

MYLONA
Greece
Central retinal artery occlusion in children is an extremely rare clinical syndrome, characterized by rapid onset of vision loss in the affected eye, which may become permanent. In most instances there is a discreet etiology uncovered after the onset of the event, with hypercoagulable states and emboli being the most frequent causes, although cases with no apparent cause are also rarely seen. The purpose of this presentation is to review the more frequent reasons for central artery occlusion in children and present a case report of an eight-year-old girl with idiopathic occlusion and poor outcome.
Hippokration General Hospital of Thessaloniki
We reviewed the cases of pediatric artery occlusion as detailed in studies published in NLM/PubMed and Web of Science and present a case report.
The surveyed published research papers point to hypercoagulable states and emboli being the most frequent causes, although cases with no apparent cause are also rarely seen. The patient was an eight-year-old girl who presented in the ED of our hospital with acute onset of vision loss in the loss of vision in her left eye. Despite prompt initiation of symptomatic treatment and initial response, the patient failed to improve. Extensive imaging and biochemical tests failed to identify a plausible reason for this presentation.
While considerable progress is being made in the understanding of causes for central retinal artery occlusion in children, there remain instances where the precise underpinning of causes may be impossible at that point in time. The patient should be followed longitudinally to assess whether the occlusion may have been the first manifestation of an otherwise undetected underlying condition.
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P260
BILATERAL PERSISTENT PUPILLARY MEMBRANE: BILATERAL OBTURATING FORM
Omar Nabih
Miscellaneous
Omar

NABIH
Morocco
Persistence of the pupillary membrane (PPM) is a congenital pathology characterized by the persistence of Tunica vasculosa lentis anterior, which normally resolves during the third trimester by the apoptotic phenomena
Surgical resection of the pupillary membrane is the technique of choice in thick pupillary membranes that completely cover the visual axis, because of the major risk of amblyopia.
We report the case of a girl referred for an esotropia, at the ophthalmologic examination we found a dense bilateral pupillary membrane blocking the visual axis.
The persistence of the pupillary membrane (PPM) is a congenital disease, due to the persistence of the Tunica vasculosa lentis anterior, this vascular layer completely disappearss at the 8th month of embryonic life thanks to apoptotic mechanisms.
Most membranes are asymptomatic and require monitoring given the risk of amblyopia which must be managed early. The use of mydriatic eye drops in some patients allows the release of adhesions of the iris collar and their detachment from the anterior capsule.
Surgical resection of the pupillary membrane is the technique of choice in thick pupillary membranes completely covering the visual axis with the risk of amblyopia.
Complications of this surgical technique are hyphema and cataracts when the membrane is vascularized adherent to the anterior crystalloid.
The persistence of the pupillary membrane obturating form is a severe pathology that requires rapid surgical management to avoid amblyopia, which must be systematically managed after the surgery.
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P261
PATIENT ATTITUDES AND BEHAVIORS REGARDING COMPLIANCE DURING CONTACT LENS WEAR
Oguzhan Ali Oruz
Miscellaneous
Oguzhan
Ali
Oruz
Turkey
Patient non-compliance is a condition that threatens the eye health of patients during contact lens (CL) wear. The aim of this study was to evaluate non-compliant behaviors in CL wearers and to examine the relationship between these behaviors and demographic and CL wear characteristics.
survey study
In this telephone survey study, 90 CL wearers who were followed up at çukurova University Faculty of Medicine, Ophthalmology Department, Contact Lens Unıt between 2016-2021 were included. Each patient was questioned by a single interviewer (an ophthalmologist, O.O.) regarding his or her CL wear characteristics (on topics such as CL wear time, daily wear time, sleeping in lenses, water activity while wearing contact lenses, wearing lenses longer than recommended, etc.) CL care practices (on topics such as poor hand washing prior to lens handling, inadequate lens cleaning and disinfecting, prolonged use of contact lens cases, etc.).
Ninety CL wearers (61 female [67.8%], 29 male [32.2%]) with a mean age of 27.8±9.1 years were included in the study 64 (71.1%) of the users expressed at least one non-compliant behavior. Major non-compliance aspects identified were rinsing lenses with tap water (n=22, 24.4%), replacing lenses less frequently than recommended (n=21, 23.3%) and sleeping in CLs (n=16, 17.7%). The mean number of non-compliant behaviors was 2.1±1.7 for the wearers younger than 25 years of age (n=37, 41%) and 1.3± 1.4 for the patients aged ≥ 25 years (n=53, 58.9%) (p = 0.011). There was no statistically significant relationship between the non-compliant behaviors and other factors such as gender, CL purchase location, CL wear time and daily wear time (p>0.05 for all).
Non-compliant behaviors related to CL wear and care can be detected in a significant proportion of CL wearers. Young wearers may be more prone to exhibit these behaviors, so more attention should be paid to training on CL wear and care in these wearers.
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P262
OCULAR DISCOMFORT FOLLOWING USE OF ARTIFICIAL TEARS IN PATIENTS UNDER TREATMENT OF INTRAVITREAL INJECTIONS OF ANTI-VEGF AGENTS
Alicia Gómez
Miscellaneous
Francisco

Pastor-Pascual
Spain
The main objective of the present study is to evaluate the benefit of artificial tears instillation in patients under treatment with intravitreal injections of anti-vascular endothelial growth factor agents.
Oftalvist Valencia, Spain
This was a randomized, prospective study considering 40 patients under treatment with intravitreal injections of anti-vascular endothelial growth factor agent (ranibizumab, 10mg/ml) for age-related macular degeneration. The study was approved by the Ethics Committee Hospital ClÍnico San Carlos, Madrid, Spain. Ocular discomfort symptoms were assessed by means of the ocular surface discomfort index (OSDI) and the Dry Eye Questionnaire-5 (DEQ-5), extensively used as an aid for dry eye diagnosis, one month after injections, and then after one month of artificial tears instillation, during a two-month follow-up period. Systane Hydration and Viscofresh 10 mg/ml artifical tears were used.
There is a reduction in ocular discomfort symptoms assessed by means of OSDI and DEQ-5 questionnaires in patients under treatment of intravitreal injections of anti-vascular endothelial growth factor agents. Statistical tests will be shown at the time of the presentation with a larger dataset. Current standard of care after intraocular injections does not include artificial tear instillation of any kind, but the outcomes of the present study suggest it should be considered for inclusion in the post-injection protocol.
Artificial tears instillation reduces patient-reported symptoms of ocular discomfort in patients being treated with intravitreal injections for age-related macular degeneration.
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P263
RELATIONSHIP BETWEEN TIME LENGTH OF DIGITAL DEVICE USAGE AND DRY EYE IN PTERYGIUM PATIENTS
Pakornkit Phrueksaudomchai
Miscellaneous
Pakornkit

Phrueksaudomchai
Thailand
To study the relationship between time length of digital devices usage and dry eye conditions in pterygium patients.
Selected population by randomized at Thammasat university hospital.
This is a Retrospective study. Consequently, information regarding demographic characteristics, characteristic and related datas of pterygium, time spent on using digital devices and Ocular Surface Disease Index (OSDI) were collected. The quantitative data was analyzed to determine the mean and relationships by using statistical tools of ANOVA, Simple linear regression and Pearson correlation.
In total, 328 samples were collected which comprised of 314 patients with primary pterygium (95.7 percent) and 14 of recurrent pterygium (4.3 percent). An average of 3.73 hours was the time spent on using digital devices. There were 249 patients (75.91 percent) which reported a history of using digital devices. The studies revealed that time spent on digital devices had no influence on pterygium size but the duration more than or equal 2 hours per day were statistically significant affected to the Ocular Surface Disease Index scores (OSDI). Relationship between the duration of the digital device usage and the eye pain (R2 = 0.026), blurred vision (R2 = 0.014) and the Ocular Surface Disease Index scores (OSDI) (R2 = 0.014) were found to be related in the same way.
Patients with pterygium were found to have the history of digital devices usage (75.91 percent). Moreover, the time spent using digital devices more than or equal 2 hours per day were statistically significant affected to the Ocular Surface Disease Index scores (OSDI). The correlation between time spent using digital devices, eye pain, blurred vision, and the severity level of the Ocular Surface Disease Index scores (OSDI) were found to be related.
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P264
MYASTHENIA-LIKE PRESENTATION POST COVID-19 VACCINE
Maria Rizk
Miscellaneous
Maria

RIZK
Lebanon
The purpose of this report is to shed light on the possible multisystem inflammatory reaction caused by COVID vaccine. This reaction can mimic auto-immune disease like mysathenia gravis and patients can present to the ophthalmolgist clinic.
A 35-year old previously healthy patient presented to our ophthalmology clinic with left fluctuating ptosis, binocular diplopia, slurred speech, diffiulty swallowing, and staggered gait two days after his second dose of COVID vaccine (Pfizer-BioNTech mRNA vaccine). No fever, no cough, no other associated symptoms. A Covid PCR was done elsewhere and was negative.
Ophthalmological exam and neurological exam were completed. MRI brain with and without gadolinium was ordered. Blood tests including acetylcholine receptor antibodies (AChR Ab), TSH, Thyrotropin Receptor Antibody (TRAb), and ESR,were ordered.
Ophthalmology exam showed best corrected visual acuity 20/20 both eyes, pupils were equal and reactive, there was no relative afferent pupillary defect, intraocular pressure was normal both eyes. Left ptosis was present and it was fatigable. Motility was full both eyes, no restriction of extra ocular muscles. Color vision was normal both eyes. Slit lamp exam and dilated fundus exam were normal both eyes.
Blood tests including AChR Ab and TRAb came back within normal ranges, and MRI brain with and without contrast was also normal.
The patient was monitored and observed closely, and his symptoms gradually resolved over the course of 2 weeks, and eventually returned to normal, without any intervention.
It was speculated that the myasthenia-like presentation of this patient post second shot of COVID vaccine was triggered by a multisystem inflammatory reaction post vaccine. A report of myasthenia gravis is described in the litterature concomitantly with a positive Covid PCR result. However, to our knowledge, this is the first case of mysathenia like symptoms happening post Covid vaccination.
This report comes to shed light on an important complication of Covid vaccine. This is important for ophthalmologists to know, because it can help both the patients and the doctor in the management.
The etiology is speculated to be either due to an autoimmune stimulation, or due to a cross reaction of SARS-Cov 2 proteins with AChR in the body.
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P265
TOXIC ANISOCORIA DUE TO DATURA STRAMONIUM
Alfonso Rubio Reina
Miscellaneous
Alfonso

Rubio Reina
Spain
The purpose is to present a clinical case of Datura stramonium poisoning with ocular involvement. This manifests as an anticholinergic syndrome 1-4 hours after ingestion and can last up to 24-48 hours. Simple contact with the eyes may produce mydriasis or anisocoria.

Case report from the ophthalmological emergency department.
We present the clinical case of a 52-year-old man with no allergies or history of interest, a gardener by profession, who came to the emergency department with blurred vision and dilated pupil in the left eye 5 hours earlier after being splashed in the face with liquid from a bush, which he identified as mad or devil's aubergine (Datura stramonium L.). He was washed with physiological saline solution and an ophthalmological examination was carried out in the emergency department, showing visual acuity of unity with both eyes, with no alteration in motility, anterior and posterior pole, only presenting unilateral mydriasis. A diagnosis of toxic anisocoria was made and transfer to internal medicine was decided, where anticholinergic syndrome was ruled out and the patient was discharged after observation for 6 hours. The patient was reviewed one day and 5 days later, with complete resolution of the symptoms after 5 days.

The diagnosis of Datura stramonium poisoning is clinical, manifesting as an anticholinergic syndrome (dry mouth, thirst, tachycardia, hypertension and in more advanced stages confusion, agitation and even coma and death) between 1-4 hours after ingestion and can last up to 24-48 hours. Simple contact with the eyes may cause mydriasis or anisocoria. Management should be multidisciplinary with internal medicine. Differential diagnosis should be made with other intoxications (atropine, tricyclic antidepressants, antihistamines and other plants). Treatment is essentially symptomatic and monitoring of vital signs.
Datura stramonium, a toxic plant of the Solanaceae family, has been used by humans since ancient times for its hallucinogenic and medicinal properties. It has a global distribution. All parts of the plant are highly toxic (it holds the world record for poisoning by poisonous plants) due to its content of atropine, scopolamine and hyoscinamine (muscarinic antagonists), which are responsible for the potentially lethal anticholinergic effect. It is well absorbed via the mucosa (conjunctiva) and digestive tract. Intoxication is described in drug addicts seeking its hallucinogenic properties and accidentally in childhood or gardening.
Due to the easy accessibility of the plant, and the high cost of other drugs of abuse, the number of these intoxications is expected to increase in the coming years. For this reason, we insist on the importance of the ophthalmologist's suspicion of the consumption of this plant in the case of anisocoria, agitation and disorientation, in order to treat the anticholinergic syndrome urgently.
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P266
COMPARISON OF METHODS TO EXPERIMENTALLY INDUCE OPACIFICATION AND ELASTICITY CHANGE IN EX-VIVO PORCINE LENSES
Manuel Ruiss
Miscellaneous
Manuel

Ruiss
Austria
Several methods to experimentally induce lens opacification in ex-vivo animal lenses for testing pharmacological substances to prevent or treat cataracts are described in the literature. However, in none of these studies the change in lens elasticity, which occurs in human age-related cataracts, was analyzed. Therefore, the aim of this study was to compare the efficacy of different methods to induce lens opacification and elasticity change in ex vivo porcine lenses.
Vienna Institute for Research in Ocular Surgery (VIROS), a Karl-Landsteiner-Institute, Hanusch Hospital, Vienna.
Porcine lenses were incubated in either culture medium, glucose, triamcinolone acetonide, sodium chloride, hydrogen peroxide, sodium selenite, neutral buffered formalin, or were exposed to microwave heating. Changes in lens morphology, weight, size, and elasticity were monitored 7 days after treatment. Experimentally induced lens opacification in the ex-vivo porcine lenses was graded by two independent masked examiners (grade 0 = no opacification, grade 3 = dense opacification).
The fastest and most dense lens opacification was induced when using microwave heating as well as incubation of lenses in neutral buffered formalin or hypertonic sodium chloride (all grade 3 opacification). However, loss of elasticity, as described for human age-related cataracts, was only seen with microwave heating and incubation in formalin solution, but not with the other methods tested.
Neutral buffered formalin- and microwave-treated ex-vivo porcine lenses seem to be a suitable model for inducing mature cataracts, whereas hypertonic sodium chloride may be useful for studies on osmolarity-induced lens opacification.
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P267
ULTRASOUND BIOMICROSCOPY OF THE ANTERIOR SEGMENT IN FUCHS UVEITIS SYNDROME
Rahma Saidane
Miscellaneous
Rahma

Saidane
Tunisia
To evaluate changes in anterior chamber parameters in Fuchs' uveitis syndrome (FUS) based on ultrasound biomicroscopy (UBM)
Department of Ophthalmology of the Military Hospital, Tunis, Tunisia.
A prospective, cross-sectional comparative study was carried out from January 2021 to September 2021. We examined twenty eyes of 10 patients with unilateral FUS. The fellow eyes served as controls.The diagnosis of FUS was made based on clinical signs including unilateral chronic anterior uveitis: typical starry keratic precipitates, low cellularity and flare in the anterior chamber, iris atrophy, and absence of any posterior synechia. Excluded were any associated immune-mediated systemic or infectious diseases by laboratory testing and medical history. Previous ophthalmic diseases were also exclusion criteria.We noted the patients' best-corrected visual acuity (BCVA), the intraocular pressure (IOP), gonioscopy, and fundus examination. Anterior segment imaging was performed on each eye using UBM (Aviso Lin-50; Quantel Medical). The following biometric parameters of the anterior segment were measured: lens vault (LV), iris Thickness (IT), angle opening distance (AOD 500), angle recess area (ARA 750), and trabecular iris space area (TISA 750). We compared all parameters between the two eyes of each patient.
The mean age of the FUS patients was 38,7 ± 5.3 years (six female and four male). The BCVA was significantly lower in eyes with FUS than in fellow eyes (0.73 ± 0.21; 1.0 respectively; p<0.05). We found Iris nodules (Koeppe nodules) in three patients, heterochromia iritis in four and glaucoma in five. IOP of fellow eyes was normal without anti-glaucoma treatment in all cases. All fellow eyes had normal ophthalmologic examination findings. All iridocorneal angle parameters (AOD 500, ARA 750, TISA750) were significantly larger in eyes with FUS than in healthy eyes (all p<0,05). The iris was thinner in FUS eyes than in healthy fellow eyes (IT=0.47 ± 0.07; 0.53 ± 0.07 respectively; p=0,036). Besides, the LV was significantly greater in FUS eyes than in fellow eyes (0.91±0.24; 0.50±0.29 respectively; p=0,012).
The iridocorneal angle is wider in eyes with FUS. The atrophy and configuration changes in the iris may be responsible for the angle widening. The UBM is a great tool to analyze the anterior segment parameters in FUS. These innovative findings could provide the background for further studies related to the association between glaucoma and FUS.

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P268
THE EFFECT OF THE COVID-19 PANDEMIC ON EYE PRACTICES IN PORTUGAL
José Salgado-Borges
Miscellaneous
José

Salgado-Borges
Portugal
In 2020 we faced the beginning of the COVID-19 pandemic in Portugal. In March 2020, the first lockdown was realized, followed by several ones to stop the spread of the virus. This situation has affected patients' visual needs and complaints, impacting eye practices and remaining essential care for emergency and priority cases. This study reports the type of visits realized during 2020 in Portugal, population habits, and eye complaints regarding visual health in the COVID-19 pandemic.

ClÍnica Oftalmológica J. Salgado Borges

833 respondents based in Portugal participated with valid anonymous responses, females 551 (66.1%), and males 282 (33.8%). More than half of the population (54%) identified a lot of discomforts caused by increasing dry eye symptoms according to more intense digital work and lens fogging up when using masks. 90% of the respondents used digital devices at least 3 hours on average per day, and 33% started using digital devices more than 8 hours on average per day. 44% of respondents felt that their near vision had worsened in these periods. The most frequent refractive problem was ametropia, astigmatism (47%) and myopia (43%). The first major symptom of presbyopia was difficulty reading smaller letters; 90% had the first symptoms at the age of 40. 298 respondents had children under 16 years, and 87% were concerned for their children's visual health, and 90.3% thought they could identify myopia symptoms in their children. More than 90% identified screens as a risk factor for myopia development; however, only 55% stated the importance of limiting the use of these devices. For parents, having good eyesight (79.5%) was the most valued aspect of their children's lives.

The findings provide an idea of the challenges during COVID-19 for eye practices. In a society highly dependent on vision, it is essential to focus on signs and symptoms that lead to ophthalmologic conditions. The excessive use of digital devices and masks during this pandemic has aggravated some of the clinics. The results are important as a point of reference to plan efficient eye care in similar situations.

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P269
OPTIC NEUROPATHY IN GAYET-WERNICKE ENCEPHALOPATHY: A CASE
REPORT
Bajjouk Salma
Miscellaneous
Bajjouk

Salma
Morocco
Gayet-Wernicke encephalopathy is a rare neuropathy caused by a thiamine deficiency and characterized by the triad: ophtalmoplegia/ nystagmus, ataxia and confusion. The prognosis for this pathology is poor; it can lead to blindness, coma or feath in the absence of thiamine supplementation.
We report the case of a 30-year-old patient with no history, 19 weeks pregnant, who is vomiting uncontrollable for several weeks in a context of weight loss and asthenia. The patient presented with a decrease in rapidly progressive bilateral visual acuity followed by balenced and walking.
The ophtalmologic examination found a corrected visual acuity of 1/10 in the both eyes, with the presence of a vertical nystagmus. Examination of the anterior segment was normal in the both eyes. Fundus examination revealed symmetrical bilateral papillary edema and sectoral. Flame hemorrhages are present along the inferior temporal branch of the central retinal artery near the papilla. Neurological examination found anterograde amnesia associated with a cerebellar syndrome. Brain magnetic resonnance imaging showed a T2 hypersignal (Flair) involving both thalami and the periacqueductal region.
We started a treatment intravenously by vitamin therapy B1: 500mg 3 times/day for the first five days, followed by 250mg/day for one weekd, associated with a regimen of rehydratation and nutrition by parenteral. The clinical ecolution was marked by the disappearence of the delirium and the decrease in cerebellar ataxia, with a favorable ocular evolution after 6 weeks of treatment. Visual acuity corrected improved to 9/10 in both eyes, nystagmus has significantly regressed.
Pregnancy vomiting is common during pregnancy and may be the cause of Gayet-Wernicke encephalopathy. A early thiamine supplementation prevents neurological and ophtalmic complications, and helps to ensure the normal continuation of pregnancy.
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P270
DIGITAL EYE STRAIN AND MASK ASSOCIATED DRY EYES DURING COVID-19 PANDEMIC IN LEBANON
Fady Sammouh
Miscellaneous
Fady

Sammouh
Lebanon
To study the contribution of quarantine with online work and education to exacerbating digital eye strain and causing possible refractive changes. To illustrate the prevalence of mask associated dry eyes and potential increase use of contact lenses.
Advanced Eye Care Hospital - Lebanon
This is a questionnaire-based cohort study including patients visiting a central specialty eye hospital in Lebanon during the period between July 1 and October 1, 2021. The questionnaire consisted of 10 multiple choice questions in both Arabic and English languages. The included age group was between 5 years and 50 years old.
The total number of questionnaires was 100. The mean age was 25.8 (6-49) years.70% of the participants where 31 years and younger and 53% were females. 73% of patients were involved in online work or education during COVID pandemic and these were divided into subcategories: online school education (25%), online university education (18%) and online work from home (30%). 83% of the patients reported an increase in screen time during quarantine. Furthermore, 59% declared worsening of their dry eye symptoms, developing dry eyes, had ocular fatigue and/or headache secondary to increased screen time (70% of the participants had an existing chronic dry eyes).
Crosstabulation analysis showed that out of the patients who reported increased in digital eye strain symptoms, 83.1% had online work or education (28.8% had online school classes, 18.6% had online university classes and 35.6% were involved in online work) while 16.9% weren't involved in any online activity. This difference was statistically significant (P=0.011)
28% of patients reported started wearing or changing their eyeglasses due to adjustments in their refractive error in the past 2 years. 44% of patients confirmed experiencing mask associated dry eyes. 20% of participants preferred to wear contact lenses instead of eye glasses to avoid the fogging effect secondary to face mask wearing.
Patients who switched to online work and education during COVID-19 pandemic had significantly higher incidence of digital eye strain. These patients were of a younger age group. However, no significant change in refraction was noted as compared to patients without online work and education. Mask associated dry eyes was noted in a large number of patients. Our results were consistent with other studies from other countries. Ophthalmologists and health care professionals should be aware about these findings when examining patients with eye strain and dryness during the pandemic.
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P271
IS POST-TRABECULECTOMY SEROUS CHOROIDAL DETACHMENT A RISK FACTOR FOR FAILURE IN THE LONG TERM
Maryam Yadgari
Miscellaneous
Kourosh

Sheibani
Iran, Islamic Republic Of

To investigate the long-term effect of serous choroidal detachment on the success of trabeculectomy in
glaucoma patients.

An academic tertiary ophthalmology center, Tehran, Iran.

In this case-control study, 17 patients who underwent trabeculectomy and developed choroidal detachment, and completed at least 3 years of follow-up were included. The controls were matched based on age, sex, preoperative intraocular pressure, glaucoma type, and lack of choroidal detachment. Surgical success was defined based on two definitions of 5< IOP< 16 and 20% reduction from the baseline and no need for further glaucoma surgery and all the same but 5< IOP< 22.

The mean estimated duration of survival ±SD was 2.73 ± 0.35 years (CI 95% 2.1, 3.4), which was significantly shorter than 3.98 ± 0.38 years (CI 95% 3.3, 4.7) in the control group. (LogRank = 5.03 p = 0.02). Cumulative probability of success was 76.5%, 52.9%, 29.4%, 17.6%, and 11.8% in year 1, 2, 3, 4, and 5 in the case group, respectively. Corresponding values were 88.2%, 82.4%, 68.6%, 58.8%, and 47.1%. In the control group, respectively. At baseline, average IOP was 22.3 ± 2.7 and 23.8 ± 8.3 mmHg in the case and control groups, respectively (p = 0.17). Mean IOP was significantly higher in the case group than in the control group in years 2, 3, 4, and 5.

Serous choroidal detachment affects the long-term surgical success of trabeculectomy, especially in patients with advanced glaucoma when lower target pressure is required.
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P272
SHORT, INTERMEDIATE AND LONG TERM RESULTS OF AHMED GLAUCOMA VALVE IMPLANTATION
Kourosh Sheibani
Miscellaneous
Kourosh

Sheibani
Iran, Islamic Republic Of
To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation for glaucomatous eyes in short, intermediate, and long term follow up periods.
Imam Hossein Medical Center, Tehran, Iran.
In this retrospective study 76 eyes of 76 patients who underwent AGV insertion in Imam Hossein Medical Center, Tehran, Iran, between January 2008 and March 2017 with at least three years of followup were included. At each visit complete ophthalmic examination was performed and the success rate of surgery was assessed. Surgical success was defined as 5 ≤ IOP ≤ 21 mmHg and at least 20 % reduction in IOP without any glaucoma medication (complete success), or with the use of anti glaucoma medication (qualified success). The sum of complete and qualified success was reported as cumulative success.
The mean age of patients was 53.18 ± 16.92 years and the mean duration of follow up was 3.27 ± 2.36 years (range: 1-5 years). The complete surgical success rate was 20 % at 1 year, 18 % at 2 years, 16 % at 3 years, 15 % at 4 years, and 8 % at 5 years of followup and there was no medication free patient at more than 5 years followup. The cumulative success rate was 91 %, 88 %, 84 %, 80 %, and 77 % at 1 to 5 years of followup respectively.
Ahmed glaucoma valve (AGV) implantation for glaucomatous eyes results in acceptable IOP reduction and less medication need in short, intermediate, and long term follow up periods.
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P273
PRETREATMENT WITH FREQUENT TOPICAL BETAMETHASONE IN AHMED GLAUCOMA VALVE IMPLANTATION
Maryam Yadgari
Miscellaneous
Kourosh

Sheibani
Iran, Islamic Republic Of

To evaluate the efficacy of pretreatment with topical betamethasone in Ahmed glaucoma valve (AGV) implantation.

Basir Eye Clinic, Tehran, Iran.
We randomly assigned patients undergoing AGV to 2 arms of the study. The case group received AGV implantation with preoperative betamethasone eye drops, and the control group did not receive preoperative betamethasone. Follow-up examinations were performed on postoperative day 1, at least weekly for 4 weeks, and then every 1 to 3 months. Our main outcome measure was the rate of success, defined as intraocular pressure (IOP)<15 mm Hg and IOP ≤18 mm Hg.
We analyzed 62 eyes divided to case (n = 33) and control (n = 29) groups. The success rate was significantly higher in the intervention group than in the control group at 12 months postoperatively when considering either IOP< 15 or IOP< 18 mm Hg as success (p< 0.001) and also at 6 months when considering IOP< 18 mm Hg as success (p< 0.041). The reduction in the number of antiglaucoma medications used postoperatively was significantly higher in the betamethasone group at follow-up at 1 and 3 months and 1 year.
Pretreatment with topical betamethasone in AGV implantations increases the success rate and reduces the need for medications.
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P274
COMPARATIVE STUDY OF CHANGES OF CORNEAL CURVATURES AND UNCORRECTED DISTANCE VISUAL ACUITY PRIOR TO AND AFTER CORNEAL COLLAGEN CROSSLINKING: 1-YEAR RESULTS
Nader Nassiri
Miscellaneous
Kourosh

Sheibani
Iran, Islamic Republic Of
Keratoconus is the most common primary corneal ectatic disease and has considerable importance in public health. Corneal collagen crosslinking (CXL) is a procedure to mitigate progression of keratoconus and reduce demand for corneal transplantation. The aim of this study was to evaluate the effect of CXL on corneal topographic and uncorrected distance visual acuity (UDVA) by Oculus Pentacam in the 15–30-year-old population.
An eye hospital, Tehran. Iran.
In this descriptive–analytic study, we enrolled 38 eyes of 27 patients suffering from progressive keratoconus who were candidates for CXL. UDVA and the anterior and posterior corneal curvatures assessed prior to and 12 months after CXL. Data were analyzed by the paired t test and p< 0.05 was considered significant.
One year after the CXL, mean UDVA significantly improved 0.1 ± 0.25 logarithm of the minimal angle of resolution (p = 0.012). Changes for steep keratometry values, flat keratometry, and mean keratometry on the anterior corneal surface were statistically significant (all p< 0.005). However, the difference observed in maximum keratometry and astigmatism was not significant (p = 0.421 and p = 0.745, respectively). After 12 months, all four keratometry values on the posterior corneal surface had increased significantly (p< 0.005), while no significant change observed in astigmatism (p = 0.303).
Corneal collagen crosslinking has been revealed as an effective and minimally invasive intervention for the treatment of progressive keratoconus that can improve UDVA.
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P275
EVALUATION OF ASYMPTOMATIC CARDIAC DISEASE IN PATIENTS WITH OCULAR PSEUDOEXFOLIATION
Maryam Yadgari
Miscellaneous
Kourosh

Sheibani
Iran, Islamic Republic Of

To evaluate asymptomatic cardiac disease in patients with ocular pseudoexfoliation.

Hazrat-e Rasool General Hospital, Tehran, Iran.
Forty-two patients with ocular pseudoexfoliation (with or without glaucoma) and 40 patients without pseudoexfoliation, who had no positive signs or symptoms of cardiac diseases, were enrolled in this study. For each participant a standard treadmill exercise test, as a noninvasive and reliable method for detecting ischemic heart disease, was performed under supervision of a cardiologist. The prevalence of ischemic heart disease was compared in the case and control groups.

The mean age of participants was 68.38 ± 8.10 years in the case and 62.45 ± 8.40 years in the control group. There was no statistically significant difference between the two groups in terms of diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. Twenty patients (47.6 %) with pseudoexfoliation and 9 participants (22.5 %) without pseudoexfoliation had hypertension (P = 0.02). There were 10 (23.8 %) positive exercise tests in the pseudoexfoliation group and 8 (20 %) positive exercise tests in participants without pseudoexfoliation (P = 0.78).

Based on our findings ocular pseudoexfoliation was not associated with increased risk of asymptomatic ischemic heart disease as evaluated by the treadmill exercise test.

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On-demand

P276
GLAUCOMA AFTER LENSECTOMY WITH MULTIFOCAL LENS IMPLANTATION IN A PATIENT WITH SPHEROPHAKIA – CASE REPORT
Marta Świerczyńska
Miscellaneous
Marta

Świerczyńska
Poland
To present a difficult case of a patient with chronic angle-closure glaucoma secondary to spherophakia who underwent lensectomy and multifocal lens implantation complicated by glaucoma.
Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia in Katowice, Katowice, Poland
A 12-year-old boy, with high myopia and shallow anterior chamber of both eyes (OU), was diagnosed with spherophakia using ultrabiomicroscopy. At the age of 22 peripheral iridotomy (LPI) OU was performed due to angle-closure glaucoma. Despite patent LPI, the iridocorneal angles were still narrow. The patient underwent selective laser trabeculoplasty OU due to the high intraocular pressure (IOP). A couple of months later, the aspirations of subluxated lenses with implantations of multifocal AcrySof reStor intraocular lenses (IOL) were performed OU.
In the next 7 years, the patient experienced numerous recurrent vitreous hemorrhages in the left eye (OS) both after blunt traumas and spontaneously. At the age of 30, he underwent pars plana vitrectomy (PPV) OS. In the next 3 years, trabeculectomy and 4 times transscleral cyclophotocoagulation OS were performed. The IOP still remained high on full pharmacological treatment. At the age of 33, multifocal lens removal with PPV OS was performed. Currently, at the age of 34, the aphakic patient remains on full topical antiglaucoma treatment and IOP is within normal limits. Best corrected visual acuity is 0,75/50 and visual field is highly constricted.
Lensectomy should be a first-line treatment for angle-closure glaucoma secondary to spherophakia. Due to combined effects of a smaller capsular bag, weakened Zinn zonules, shallow anterior chamber and common peripheral anterior and/or posterior synechiae, the surgery is difficult and associated with high risk of complications. Despite successful procedure, the IOP may remain uncontrolled, especially when blunt trauma occurs. Therefore, the implantation of multifocal IOL seems to be risky in post-spherophakic eyes and it may be required to remove multifocal IOL in the case of malignant glaucoma.
Eposter
On-demand
On-demand

P277
UNILATERAL CONGENITAL GLAUCOMA WITH BUPHTHALMOS IN TWO SISTERS - CASE REPORTS WITH LONG TERM FOLLOW-UP.
Agnieszka Tronina
Miscellaneous
Agnieszka

Tronina
Poland
To enhance the exploration of an excellent management approach for familial congenital glaucoma. Primary congenital glaucoma is a rare condition but the most common form of glaucoma in infants. It is considered as an autosomal recessive hereditary entity, however, there are known cases of its occurrence as a result of de novo genetic mutations.
Department of Pediatric Ophthalmology, University Clinical Center for Ophthalmology and Oncology prof. K. Gibińskiego, Medical University of Silesia in Katowice, Poland
We report on two siblings with unilateral ipsilateral congenital glaucoma. Both sisters presented with corneal clouding at the time of diagnosis, and one sister presented with Haab lines. In both, the trabeculectomy procedure was performed less than 2 months after diagnosis and within 6 months of life.
A 5-month-old girl and her parents presented to the Children's Ophthalmology Outpatient Clinic because of a slight corneal clouding noticed by the pediatrician. The family history of ophthalmic diseases was not significant. Anterior fundus examination revealed a single Haab line and corneal clouding in the left eye due to corneal oedema, and the fundus was within normal range for her age. The intraocular pressure (IOP) was 14 mmHg for the right eye and 34 mmHg for the left eye, respectively. The corneal diameter of the left eye was 13.5 mm. Local adjuvant treatment was instituted and a trabeculectomy with iridectomy was performed in the sixth month of the child's life, which resulted in normalization of IOP. The same situation was observed in the patient's sister, who three years later, at the age of 4 months, also came to our outpatient clinic with corneal haze, but without Haab lines on left anterior segment examination. IOP was 13 mmHg and 22 mmHg, respectively. Since attempts to stabilize the IOP with topical medications were unsuccessful, it was decided to perform a trabeculectomy with iridectomy of the left eye in the second patient likewise. In both patients, during the period of almost 15 years of follow-up, there was no recurrence of intraocular pressure elevation, no morphological changes of the retina of the affected eye, which could suggest the occurrence of glaucoma or the progression of the disease, were ever observed.

The essence of congenital glaucoma is dysgenesis of the iridial angle with the presence of fetal tissue remnants within it. In familial cases of congenital glaucoma, the homogeneous etiology of the abnormality along with the genetic background allows for excellent results with the application of the same treatment method in related patients. With trabeculectomy performed soon after the diagnosis of congenital glaucoma in children, long-term follow-up shows long-term stabilization of intraocular pressure and absence of resulting secondary changes.
Eposter
On-demand
On-demand

P278
DO THOSE HELPING US SEE AS CLEARLY AS THEY NEED?
Tatiana Tziola
Miscellaneous
Tatiana

Tziola
Greece
Theatre nurses play a significant role in the fast-paced and often stressful operating theatres' environment. Undiagnosed presbyopia may act as an additional burden, especially when working as a scrub nurse. In this study, we aim to define the refractive status of the nursing stuff in the operating theaters and the need for near vision (NV) correction spectacles.
All of the theatre nurses of a single tertiary hospital in Greece were included in the study.
Data was gathered on demographic factors, previous refractive status and ocular healthcare seeking behaviours. Subjective refraction (ETDRS) and examination on the slit lamp was performed.Descriptive analysis of all the data was performed and the relationship between previously undiagnosed or undercorrected presbyopia and age, the feeling of inadequate near Vision (NV), length of work experience as theatre nurse and working in the operating theatres with subspecialties with high near vision demands was determined using univariate regression analysis.
A total of 37 theatre nurses were identified. A change in the refractive status was identified in 54% and a need of new NV spectacles or a change in their current prescription was identified in 43% which was considered significant (P=0.0138). Increasing age was the only factor found to be significantly associated with a previously undiagnosed or undercorrected presbyopia in our sample (P=0.0069).
A significant proportion of theatre nurses were found to have previously undiagnosed refractive errors.Regular annual ophthalmic checks can prevent suchevents and allow them to achieve optimal near vision, favorably affecting their abilities as scrub nurses.
Eposter
On-demand
On-demand

P279
RETROSPECTIVE ANALYSIS OF OPHTHALMIC REFERRALS FROM COMMUNITY HOSPITAL EMERGENCY DEPARTMENTS
Lily Xu
Miscellaneous
Lily

Xu
Canada
Telemedicine has shown merit in improving emergency department (ED) triage accuracy of ocular complaints. This study aims to characterize referrals from the ED to ophthalmology at a community practice in Kitchener-Waterloo, Canada in order to identify areas of ophthalmic care that may be enhanced with the addition of a teleophthalmology platform.
This retrospective case series included patients referred from an ED to an on-call ophthalmology service at the Ocular Health Centre in Kitchener, Ontario between January 2021 and July 2021. Patients who did not attend the consultation appointment were excluded.
The primary outcome was percent agreement between the referring physician and the ophthalmology service on exact diagnosis and on classification of ocular pathology. Secondary outcomes included average patient wait times in the ED, number of CT imaging tests done, and number of appropriate CTs based on the ophthalmologist's diagnosis. Logistic regression was done to identify factors that contributed to diagnostic agreement.
196 patients (mean age: 46.6, 51.5% female) were included. Exact diagnostic agreement was 46.9% and agreement based on classification was 61.2%. Mean [standard deviation] ED wait time was 3.2 [2.2] hours. 24 CTs were done, of which 10 were deemed appropriate based on final diagnosis. 3 patients received a final diagnosis that would warrant a CT but did not receive one in the ED (Cohen's kappa [95% confidence interval] = 0.50 [0.29, 0.70], p<0.001). Multivariate logistic regression found that ocular surface pathology (p<0.01), posterior segment pathology (p<0.05), and increased time between referral and consultation (p<0.05) were associated with increased agreement based on classification.
Diagnostic agreement is moderate between emergency physicians and on-call ophthalmologists, and improved when the diagnosis involved the ocular surface or posterior segment. Future studies should assess whether a teleophthalmology service improves wait times and diagnostic agreement for patients presenting to the ED with urgent ocular complaints.
Eposter
On-demand
On-demand

P280
QUANTITATIVE ANALYSIS OF PRECLINICAL OCULAR MICROVASCULAR CHANGES IN MULTISYSTEMIC INFLAMMATORY SYNDROME IN CHILDREN (MIS-C) DETECTED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Busra Yilmaz Tugan
Miscellaneous
Busra

Yilmaz Tugan
Turkey
To evaluate the macular and optic nerve head (ONH) vascular density, foveal avascular zone area, and outer retina and choriocapillaris flow in Multisystemic Inflammatory Syndrome in Children (MIS-C) using optical coherence tomography angiography (OCTA).
Kocaeli University Department of Ophthalmology and Department of Pediatric Rheumatology
Thirty-four eyes of 34 patients with MIS-C and 36 age and sex-matched healthy controls were investigated in this prospective, cross-sectional study. The superficial capillary plexus (SCP) and deep capillary plexus (DCP), ONH, FAZ parameters, the flow area of the outer retina, and choriocapillaris were evaluated using OCTA.
All VD parameters in SCP were significantly lower in MIS-C patients. Although VD parameters of both DCP and ONH, as well as FAZ area and FAZ perimeter were lower in MIS-C group compared to the control group, these differences were not statistically significant. However, foveal density (FD-300) was significantly decreased in the MIS-C group. (p=0.024). The outer retina flow area at 1 mm, 2 mm, and 3 mm radius and CC flow area at 1 mm and 2 mm radius were significantly lower in the MIS-C group than in the control group. Although CC flow area at 3 mm radius was decreased in the MIS-C group compared to healthy controls, the difference was not statistically significant.
We demonstrated a decreased vessel density in SCP, choriocapillaris flow area, and outer retinal flow area in MIS-C patients. Hence, we proposed that OCTA could reveal retinal microvascular changes in MIS-C patients who were completely healthy before the diagnosis of MIS-C.
Eposter
On-demand
On-demand

Sheet 2: Case Reports

Abstract Final Identifier
Title
Presenting Author
Abstract Topic Name
Submitter First Name
Submitter Middle Name
Submitter Last Name
Submitter Country
Purpose
Setting
Report of case
Conclusion / Take home message
Session 1 - Name
Session 1 - Presentation Start
Session 1 - Presentation End
Session 1 - Presentation Order

CR01
BILATERAL ACANTHAMOEBA KERATITIS IN A MINOR SECONDARY TO ORTHOKERATOLOGY LENS WEAR
Magdalena Niestrata
Infectious keratitis
Magdalena

Niestrata
United Kingdom
To report bilateral Acanthamoeba keratitis (AK) in a young patient wearing orthokeratology lenses and to highlight the risk of sight threatening infection in minors secondary to this increasingly used treatment of myopia.
Specialist Corneal Clinic in Ophthalmology Department at Queens Hospital in London, UK.
A 14 year old female presented with a one week history of painful, red, photophobic eyes, which had not improved despite ceasing the contact lens immediately following the onset of symptoms and having used topical antibiotics. She was using rigid gas permeable (RGP) orthokeratology lenses for myopia overnight only. She was not using other contact lenses and followed rigorous contact lens hygiene, with no reported use of tap water.
The vision at presentation was LogMAR 1.0 (pinhole 0.7) and 1.0 (pinhole 0.8) in the right and left eye, respectively. Slit lamp biomicroscopy showed pseudodendritiform epitheliopathy, radial perineuritis and severe limbitis. A clinical diagnosis of Acanthamoeba keratitis was made, which was subsequently confirmed by PCR taken at presentation. Treatment with hourly G Polyhexamethylene Biguanide (PHMB) 0.02% and G Brolene 0.1% to both eyes was commenced. She was followed up closely in the specialist corneal clinic. The first signs of improvement were noted 2 days after commencing the treatment, however, one week later, her eyes were more inflamed with significant radial perineuritis bilaterally, therefore, the strength of G PHMB was increased to 0.06%. Within another week the patient started to improve symptomatically and epithelial debridement was performed in the right eye to remove any infected surface cells and promote better drop penetration. She continued to improve symptomatically and clinically throughout the next 3 months, at which point G Brolene was stopped and monotherapy with G PHMB 0.06% was continued. Four months after commencement of treatment symptoms were significantly improved with normal corneal appearances and best corrected vision with glasses of LogMAR 0.30 (pinhole 0.12) and 0.24 (pinhole 0.08) in the right and left eye, respectively. She continues to improve on current treatment.

Acanthamoeba keratitis is an emerging complication of orthokeratology in young myopes. Although myopia progression remains a significant public health issue, the proportion of AK amongst minors using orthokeratology lenses appears to exceed the expected risk profile. Therefore, caution should be exercised when selecting appropriate treatment options for myopia and alternatives should be considered. In young patients using orthokeratology, a high index of suspicion, prompt diagnosis and treatment is paramount for good clinical outcomes.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
1

CR02
CHALLENGES IN THE MANAGEMENT OF FUNGAL KERATITIS – CASE REPORT
Pedro Nuno Pereira
Infectious keratitis
Pedro
Nuno
Pereira
Portugal
Corneal infections are an important cause of blindness worldwide. Fungal keratitis (FK) represents one of the most severe forms of corneal infections due to its difficult diagnosis and treatment. The use of contact lens without proper hygiene conditions has become an important risk factor for FK in developed countries. Other factors are ocular trauma, previous ocular diseases, the use of topical corticosteroids and systemic immunosuppression. An early and accurate diagnosis is crucial to implement an appropriate treatment in a timely manner and to avoid potential complications and irreversible visual loss.
Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
A healthy 52-year-old contact lens wearer, presented on the emergency room (ER) with a 7-day history of foreign body sensation, redness and itching on the right eye. She mentioned an episode of ocular trauma with organic matter after sweeping a balcony. Slit-lamp examination showed a 2mm corneal epithelial defect and stromal infiltrative. No abnormalities were detected in left eye. Microbial specimens were collected, and the patient started on topical ciprofloxacin ointment and tobramycin and ceftazidime eye drops. Due to the lack of clinical improvement, with deterioration of best visual acuity (1/10) and worsening of the stromal infiltrate, the patient was admitted and, suspecting a diagnosis of keratomycosis, antifungal treatment was started with oral - posaconazole (300mg/day) and voriconazole 10mg/ml eye drops every hour. The microbiological analysis revealed the fungus Fusarium spp. With the diagnosis of Fusarium keratitis, intrastromal and intracameral voriconazole were performed 3 times and intravenous voriconazole added to the treatment. Despite the topical and systemic antifungal therapy, there was no clinical improvement and, due to the risk of perforation, a tectonic penetrating keratoplasty (PK) was performed. Tectonic PKs were performed again twice over the next 3 months, first because of a new fungal infiltrate in the first corneal graft and second because of corneal graft melt and perforation. The patient was continued on oral Posaconazole and topical voriconazole and amphotericin eyedrops. After her 3rd PK, chlorhexidine and povidone iodine diluted eyedrops twice a day were added to the treatment regimen. With this new regimen, the corneal graft remained clear, with no signs of fungal recurrence or inflammation.
Fungal keratitis is an important cause of ocular morbidity and blindness. It represents a clinical challenge due to its difficult differential diagnosis from other microbial keratitis. Fungus identification using microbiological techniques is essential for an early diagnosis, which allows the timely treatment and avoids irreversible complications. We report a case that documents the effectiveness of topical iodine povidone as an adjunctive treatment for refractory Fusarium keratitis, resistant to other triazoles and conventional antifungals.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
2

CR03
PACK-CXL IN INFECTIOUS KERATITIS: FIRST-LINE OR SALVAGE TREATMENT?
Chiara Bonzano
Cornea
Chiara

BONZANO
Italy
To report a successful Photoactivated Chromophore for Keratitis-Corneal Collagen Cross-Linking (PACK-CXL) as initial treatment in Serratia marcescens keratitis.
Clinica Oculistica, Di.N.O.G.M.I. University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy.
An 87-year-old Caucasian male presented to our cornea service complaining about blurry vision within his left eye for about two days. Our first evaluation revealed lagophthalmos, cicatricial ectropion, a corneal ulcer with 5-mm-diameter fluorescein staining, and an inferior hypopyon of 2.0 mm. The right eye was within normal limits. His medical history was positive for left eye cornea perforation managed by cyanoacrylate glue corneal patch and a bandage contact lens three months earlier. Carefully interviewed, he reported basal cell carcinoma localized on the forehead, left temple, left cheek, and left medial canthus treated by surgical excision one year earlier. Neither diabetes nor herpes infectious were reported. On the day of admission, we performed in vivo confocal microscopy, negative for fungal and Acanthamoeba features, and a corneal scraping. Being the clinical picture suggestive for bacterial keratitis, we firstly performed PACK-CXL. Then, hourly topical fortified antibiotics plus bandage contact lens were administered. The hypopyon disappeared 24-hour later, and the corneal ulcer improved after a few days. Corneal scraping revealed a multidrug-resistant Serratia marcescens. Corneal healing was evaluated by corneal examination and by anterior segment OCT. Two weeks later, the cornea markedly ameliorated with combined improvement in visual acuity. After treatment, only minimal residual corneal scarring remained.
After appropriate oncological surgery on the eyelids, the reconstruction must be extremely precise to preserve the eyelid function and avoid consecutive exposure keratopathy and infectious keratitis. Performed as first-line treatment, PACK-CXL has been extremely useful in treating Serratia marcescens keratitis. It has shown a triple benefit: avoiding re-perforation by immediately stopping corneal melting and quickly stopping infection, which can become increasingly important in the context of increasing antimicrobial resistance. It also prevented emergency keratoplasty, which is associated with higher rates of infection and rejection.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
3

CR04
STROMAL LENTICULE IMPLANTATION USING SMILE SURGERY FOR MANAGEMENT OF STROMAL HERPETIC KERATITIS-THREE YEAR RESULTS-CASE REPORT
Anita Syla Lokaj
Cornea
Anita

Syla Lokaj
Albania
Purpose: To evaluate corneal transparency,Imporving visual acuity, and whether there is recurrence by removing the corneal scar after herpetic infection with femtolaser small incision lenticule extraction (SMILE) surgery and implanting the lenticule equal to the volume of removed scar tissue as surgical adjuvant to seal stromal scar after herpetic infection.
Department of Ophthalmology, Eye Hospital, Prishtina, Kosova
Methods: Corneal stromal lenticule obtained through SMILE surgery with central thickness 100 μm or more was implanted through side port in stromal pocket of recipient patinets with chronic recurrent stromal herpertic keratitis. A patient who has been followed up for a minimum of 36 months was assessed using slit-lamp biomicroscopy, AS-OCT, corneal topogrpahy, and best spectacle-corrected visual acuity (BSCVA) measurements. Postoperative complications were recorded throughout the follow up period.
Results: Stromal haze and scar had successfully been sealed in that patient; a pacient exhibited improved postoperative BSCVA. During the follow-up period of three year, no signs of recurrence or rinfections were detected in this patient.
Conclusions: These early findings suggest that the use of corneal stromal lenticules with stromal stem celle and live keratocites could be a safe and efficient surgical adjuvant for stromal scar after herpetic keratitis with potential clinical application, as relatively simple and low cost procedures that offering advantages over corneal transplantation as a definitive procedure in the treatment of this disease
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
4

CR05
INFECTIOUS KERATITIS DUE TO MORAXELLA LACUNATA: A CASE REPORT
Ana Maria Ceausescu
Infectious keratitis
Ana Maria

Ceausescu
Spain
To describe the Clinical Characteristics, Management, and Treatment of Moraxella lacunata keratitis.
Department of Ophthalmology, Marina Baixa Hospital, Villajoyosa 03570, Alicante, Spain.
A 53-year-old man presented to our emergency department with a 3-days history of pain, photophobia, and decreased vision in his right eye. Previous ocular, medical and family histories were unremarkable except for smoking. His best-corrected visual acuity was 20/100 in the right eye and 20/20 in the left eye. Intraocular pressure was normal in both eyes.
Slit-lamp biomicroscopy of his right eye revealed a ciliary injection and a central corneal infiltration with an extensive epithelial defect. We performed corneal ulcer scraping and after that we started topical treatment with fortified ceftazidime 50 mg/ml and tobramycin 15mg/ml every hour. We added also cyclopentolate 0.5% twice a day.
After two days of intensive treatment the clinical features worsened with the appearance of hypopyon and an increase in stromal infiltration and more epithelial defect.
The culture results revealed Moraxella lacunata sensitive to ceftazidime, moxifloxacin, gentamicin, and amikacin and we decided to change the treatment replacing tobramycin with moxifloxacin.
After shifting the topical antibiotics, the keratitis was controlled and 2 months later the patient presented a paracentral corneal leucoma and his best-corrected visual acuity has improved to 20/30.
The corneal infection caused by Moraxella species characteristically has an indolent paracentral or peripheral ulcer that is usually oval in shape and associated with hypopyon or hyphema.
Microbial keratitis is a serious ocular infectious disease characterized by a corneal epithelial defect and underlying stromal infiltrate that can lead to significant stromal scarring, corneal perforation, and visual loss.
Appropriate therapy is very important and topical antibiotics remain the best treatment for bacterial keratitis. Empirical treatment with broad spectrum antibiotics, usually fortified aminoglycoside–cephalosporin or topical fluoroquinolone, is often the primary therapy which can then be modified according to cultured organisms and antibiotic sensitivities.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
5

CR06
A RARE CASE OF PERSISTENT EPITHELIAL DEFECT AND DECREASED CORNEAL SENSATION CAUSED BY CORYNEBACTERIUM PROPINQUUM KERATITIS
Ricardo Machado Soares
Infectious keratitis
Ricardo José Dos Santos

Machado Soares
Portugal
To report the case of a patient with a central persistent epithelial defect (PED) and decreased corneal sensation due to Corynebacterium Propinquum Keratitis.
Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
A 51-year-old woman presented at the ophthalmology outpatient clinic with complaints of blurred vision and hyperemia in her left eye (LE) for one week. She had no complaints of discomfort or pain. The patient was a contact lens wearer and had a history of left acoustic neuroma removal, thyroid eye disease, and concomitant lagophthalmos.
Biomicroscopy of the LE revealed a 3 × 3 mm central epithelial defect with mild signs of ulceration. A cotton-tipped swab was used to collect the ulcer base exudate for bacterial culture. Pseudomonas aeruginosa Keratitis was presumed, and the patient initiated topical moxifloxacine and tobramycin. At 2-weeks of follow-up, the patient maintained a central epithelial defect and minimal improvement, despite the optimized medical therapy, and the bacterial culture was uneventful. Due to the lack of corneal sensation, a possible neurotrophic component was suspected and the patient initiated plasma rich in growth factors. A therapeutic contact lens and prophylactic topical fluoroquinolone were also applied. After three days, the patient presented with an increase of the PED and corneal exsudate. The Bacterial culture was repeated and a Corynebacterium Propinquum, which was only susceptible to Gentamicin, was isolated. Fortified topical Gentamicin was readily initiated and the PED resolved in 7 days.
Pseudomonas Aeruginosa Keratitis is often the presumed diagnosis of contact lens users' corneal infections. In cases of atypical presentation, less common bacterial agents must be considered alongside other pathogens. Corynebacterium spp. Keratitis may present with decreased corneal sensation and fluoroquinolone resistance, leading to misdiagnosis with Neurotrophic Keratitis.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
6

CR07
A RARE CASE OF THAUMETOPOEA PITYOCAMPA KERATOCONJUNCTIVITIS
Ricardo Machado Soares
Infectious keratitis
Ricardo José Dos Santos

Machado Soares
Portugal
To report the case of a patient with Thaumetopoea pityocampa Keratoconjunctivitis.
Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
A 60-year-old woman presented at the emergency ward with complaints of ocular discomfort, blurred vision and hyperemia in his left eye (LE) for one month. He added that he first noted these complaints while riding a bicycle and denied history of ocular trauma. He was previously diagnosed with bacterial conjunctivitis refractory to several topical antibiotics.
At examination, LE best-corrected visual acuity was 6/10, and biomicroscopy revealed diffuse conjunctival hyperemia alongside ciliary injection. Small stromal filaments resembling Thaumetopoea pityocampa's hairs were seen in the cornea's inferior and temporal regions. These processionary setae were hyperreflective in the anterior segment optical coherence tomography and could not be removed as they were lodged in the stroma. A diagnosis of Thaumetopoea pityocampa Keratoconjunctivitis was established, and the patient initiated prophylactic treatment for possible pathogens on the hairs. After two weeks of treatment, the patient was free of complaints.
The diagnosis of Thaumetopoea pityocampa Keratoconjunctivitis resides in the presence of the setae in the cornea. Ocular complications of these patients are usually self-limiting, although severe cases with long-lasting sequelae may happen.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
7

CR09
NOCARDIA CYRIACIGEORGICA KERATITIS: A CASE REPORT
Rita Rodrigues
Infectious keratitis
Rita

Rodrigues
Portugal
To describe a case of a patient with an extensive corneal ulcer caused by Nocardia cyriacigeorgica.
Ophthalmology Department, São João University Hospital, Porto, Portugal.
We report the case of a 50 year-old male patient presenting to the emergency department of our center with decreased vision, redness, pain and watering in the left eye for the past 3 weeks. There was history of two small central epithelial defects in left eye, as a result of trauma with a stone, treated 4 weeks earlier. Best corrected visual acuity in left eye was counting fingers. On examination an extensive central corneal ulcer (7x6 mm) with well-defined margins, endothelial plaque, deep stromal infiltrate and melting was present. There was evidence of 3+ anterior chamber reaction and 1mm hypopyon. Corneal scrapings were performed for smears and cultures which identified the presence of Nocardia cyriacigeorgica. The patient was treated with hourly topical fortified amikacin and hourly topical and intravenous (15 mg/kg/day) trimethoprim-sulfamethoxazole and admitted to Infectious Diseases Department where systemic involvement was ruled out. Corneal ulcer showed improvement with treatment, however 3 weeks after first observation significant corneal scarring was present and the patient was proposed for therapeutic corneal penetrating keratoplasty.
Nocardia keratitis is a rare entity, frequently misdiagnosed due to its atypical clinical presentation. Suspicion should be raised in patients with long-standing corneal ulcers not responsive to topical conventional treatment and with prior eye trauma with stones, vegetable matter and metallic foreign bodies. Topical amikacin is the mainstay of treatment. Nocardia keratitis diagnosis is challenging, thus, knowledge of its clinical presentation and management holds the key for a good outcome.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
9

CR10
RECURRENT CORNEAL PERFORATION REPAIR WITH AMNIOTIC MEMBRANE PLUG TECHNIQUE
Renato Correia Barbosa
Infectious keratitis
Renato
Correia
BARBOSA
Portugal
To report a case of a relapsing corneal perforation due to herpetic keratitis, in a 70-year-old male patient, treated with an amniotic membrane plug surgical technique.
Management of the patient, including the surgical procedure and pre- and post-operative periods, took place in Hospital Pedro Hispano – ULSM, in Matosinhos, Portugal. The described surgical treatment was performed by Dr. Rita Gonçalves and Dr. Ricardo Bastos.
A 70-year-old male patient had a history of three corneal perforations due to relapsing herpetic keratitis. Surgical repair using an amniotic membrane graft was tried two times, with recurrence of perforation shortly after both procedures. Due to this history of relapse, he was admitted a third time for surgery, and a new surgical technique was carried out.
First, the perforated graft applied during the last surgery was removed. Anterior iris synechiae were disrupted and necrotic tissue at the base of the ulcer was carefully removed. Then, an amniotic membrane fragment was rolled to a length of 2 mm. One end of the roll was plugged into the perforation, and the other end was spread over the defective stromal area. Crisscrossing sewing was used to anchor the plug inside the ulcer. Then, a single layer of amniotic membrane was trimmed and folded in half to become a basement membrane for reepithelization, and its edge was sutured to episcleral and corneal tissue. Finally, a larger piece of amniotic membrane was applied over the entire surface of the cornea and anchored with a continuous suture. A 0,3 mL bubble of 20% C3F8 mixed with air was injected into the anterior chamber to preserve its depth in the early postoperative period.
During the 14 months of follow-up, the perforation did not relapse. The patient maintained a deep anterior chamber, and anterior synechia did not occur.
Severe herpetic keratitis may lead to corneal perforation, which may relapse several times, even after conventional surgical treatment using an amniotic membrane graft. The management of those patients may present a complex challenge, especially when complications recur after all therapeutic options have been tried.
In this report, we present an example of an alternative surgical technique for the management of those complex cases.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
10

CR11
REFRACTORY KERATITIS: A MICROBIAL COCKTAIL OR INFECTIOUS ENIGMA?
Ritika Mukhija
Infectious keratitis
Ritika

Mukhija
United Kingdom
To report an unusual case of chronic recurrent keratitis diagnosed as viral, bacterial and fungal at various stages in the course, wherein histopatholgy performed at the time of penetrating keratoplasty for visual rehabilitation revealed evidence of microsporidial keratitis.
Tertiary care eye hospital
A 39-year-old male patient underwent penetrating keratoplasty for visually significant corneal scarring in his right eye resulting from multiple episodes of infective keratitis over the course of nearly three years. Past ophthalmic history included secondary optic atrophy in other eye, and past medical history included chronic alcoholism with abstinence for over 3 years at the time of surgery. He initially presented to eye casualty with sudden onset painful blurring of vision in his right eye and was diagnosed and managed as herpetic disciform keratitis. The episodes kept recurring every few months despite oral acyclovir prophylaxis; though, they always responded well to therapeutic oral acyclovir and topical steroids. Few weeks after the third recurrence, he presented with secondary microbial infection with multiple stromal infiltrates on a background of previous stromal and endothelial scarring. In view of poor response to antibiotics, negative corneal scrapes and clinical appearance of dry infiltrates with feathery margins on a background of prolonged use of topical steroids, fungal keratitis was suspected and in-vivo confocal microscopy requested, which identified possible hyphae. Patient was thereafter treated with topical natamycin which resulted in resolution of keratitis over the next few weeks.
Unfortunately, he had a few more similar episodes, and in view of the recurrences, tear film sample was sent for viral PCR testing, which was interestingly positive for cytomegalovirus and negative for herpes simplex and herpes zoster virus. Baseline blood tests requested to rule out any underlying systemic pathology revealed normal full blood count, ESR, CRP, serum urea and electrolytes and fasting blood sugar along with negative HIV 1 & 2 and VDRL serology. Finally, histopathology of his cornea which was sent during penetrating keratoplasty revealed numerous tiny oval organisms positive for acid fast, Periodic acid–Schiff, and silver methanamine stains, consistent with a diagnosis of microsporidial stromal keratitis.
This case highlights an atypical presentation of microsporidial keratitis, which though relatively rare, is an important cause of keratitis in both immunocompetent and immunosuppressed individuals. In our case, it is difficult to say whether microsporidia were the causative organisms from the first episode, but it is more likely that they were acquired as a possible opportunistic infection later during the course. It is important to consider these organisms as a possible differential in stromal keratitis and to remember that they can mimic recurrent herpetic keratitis. High index of suspicion is needed for prompt diagnosis and treatment.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
11

CR12
THE COMPREHENSIVE TREATMENT OF FUNGAL KERATITIS BASED ON CORNEAL COLLAGEN CROSS-LINKING AND KERATOPLASTY.
Svetlana Borisovna Izmailova
Infectious keratitis
Svetlana
Borisovna
Izmailova
Russian Federation
To develop an effective algorithm of fungal keratitis treatment based on corneal collagen cross-linking and keratoplasty.
S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.
A 63-year-old Caucasian male with past history of recurrent herpetic keratitis since 1989 with relapses each 5-6 years, presented with complains of low visual acuity, pain, photophobia, excessive lacrimation from the right eye for few weeks. Before the visit to ophthalmologist patient began to use topical antibiotics. At first examination BCVA on right eye was proectio lucis certae, on left eye - 0.03 (equivalent to 20/600) due to amplyopia. Slit lamp biomicroscopy revealed a corneal ulcer of approximately 3 mm х 4 mm in size, a hypopyon 3 mm in hight, opacification of the cornea and lens. Scraping from the cornea was collected for microbiological analysis on blood agar and Sabouraud dextrose agar (SDA). Grown in SDA culture was identified as Candida albicans. The patient was prescribed intravenous Fluconazole, oral Terbinafine. After hypopyon regression corneal collagen cross-linking was performed as adjuvant therapy. A month later, according to the results of anterior segment OCT, progressive thinning and opacity almost to the entire depth of the cornea was revealed. It was decided to perform penetrating keratoplasty and simultaneously phacoemulsification of cataract with implantation of an intraocular lens (IOL). It is planned to carry out an three-step optical-reconstructive surgery. By first step, using femtosecond laser opacified superficial layers of cornea were removed to improve visualization for the next step. By second step, a 'closed-globe' uncomplicated phacosurgery was performed. And after all, by third step, to remove opacified residual layers of the cornea penetrating keratoplasty was successfully performed. 2 months later the eye is not irritated, the graft is transparent, the IOL is in the correct position.
Corneal collagen cross-linking seems to be a safe and effective procedure for the management of fungal keratitis, and together with subsequent anterior lamellar or penetrating keratoplasty may allow to achieve good anatomic and functional outcomes.
Cornea Day: Section 1: Infectious keratitis (EU Cornea)
18.02.2022 09:30
18.02.2022 10:50
12

CR13
POST LASIK EPITHELIAL INGROWTH AFTER IOL EXCHANGE
Vivian Paraskevi Douglas
Management of corneal complications after refractive surgery
Vivian Paraskevi

Douglas
Greece
To describe the mechanism of epithelial ingrowth formation after intraocular lens exchange.
Naval and Veterans Hospital, Athens, Greece
A 62-year-old Caucasian female with no significant past medical history presented to our department with dysphotopsia and decreased vision in the right eye (OD). The patient had undergone bilateral uneventful refractive lens exchange (RLE) with trifocal intraocular lens implantation by an outside ophthalmologist, 7 months before presentation. Three months after RLE, uncomplicated femtosecond LASIK was performed by the same ophthalmologist in order to correct residual astigmatism. Two months after LASIK surgery, the trifocal IOL was replaced by a monofocal IOL in OD (by the same outside ophthalmologist), due to persisting significant dysphotopsia (significant glare and halos). Best spectacle corrected visual acuity (BSCVA) at presentation was 0.2 and 0.7 in OD and OS, respectively. Intraocular pressure (IOP) was 11 mmHg in both eyes. Localized inferonasal stromal edema was noticed in OD. A small gap at the inferotemporal edge of the LASIK flap was noticed at the slit lamp, alongside with diffuse opacification at the level of the LASIK flap interface. Anterior Segment Swept Source Optical Coherence Tomography (AS-SS-OCT) and AS - Spectral Domain - OCT (AS-SD-OCT) revealed accumulation of fluid in the interface resulting in localized edema and irregular astigmatism. The small secondary gap at the edge of the LASIK flap was also confirmed by AS-SD-OCT. Over the next 4 months, despite absorption of interface fluid, epithelial ingrowth started to form in the same area, that progressed further over the following 3 months. Interface fluid accumulation was attributed to iatrogenic endothelial cells distortion during IOL exchange procedure. However, the presence of fluid at the interface caused small dehiscence at the edge of the LASIK flap, that allowed epithelial cells to migrate and proliferate at the interface, resulting in the formation of epithelial ingrowth.

Endothelial damage is a known complication of cataract surgery and IOL exchange.1 Interface fluid syndrome (IFS) and epithelial ingrowth following LASIK procedure have been described and are usually seen within the first month post-surgery.2 We postulate that even temporary endothelial distortion at any time point after LASIK surgery may result in LASIK flap edge dehiscence and secondary epithelial ingrowth formation. Clinicians should reverse endothelial insufficiency as early as possible and prevent ingrowth formation in such cases.
References: 1.Goemaere J, Trigaux C, Denissen L, et al. Fifteen years of IOL exchange: indications, outcomes, and complications. J Cataract Refract Surg. 2020;46(12):1596-1603./2. Sahay P, Bafna RK, Reddy JC, Vjpayee RB, Sharma N Complications of laser-assisted in situ keratomileusis.Indian J Ophth 2021;69(7):1658-1669

Cornea Day: Section 2: Complications after surgery and primary and secondary ectasia (EU Cornea)
18.02.2022 10:50
18.02.2022 12:00
1

CR14
LASIK NIGHTMARE - INCOMPLETE AND LOST FLAP
Celso Cabral Costa
Management of corneal complications after refractive surgery
Celso
Cabral
Costa
Portugal
To report the management and outcome of a serious microkeratome LASIK complication.
Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Portugal
A 43-year-old female was referenced to our department after a history of incomplete and lost flap, when attempting to perform microkeratome LASIK on her right eye.
Her pre-operative right eye refraction was -1.75 D and her best-corrected visual acuity was 0.0 logMAR. Topography showed a regular with-the-rule astigmatism with normal keratometry readings.
According to the referral letter, there was a suction loss during the microkeratome excursion. The result was a partial temporal free cap, which was lost and consequently not repositioned.
Her post-operative refraction was -0,50 -7,00 x 80º and her best-corrected visual acuity was 0.8 logMAR. Topography showed two half-divided cornea regions, one very steep with high K values and another one very flat with low K values. The AS-OCT showed a localized loss of epithelium and stroma.
We performed phototherapeutic keratectomy and topography-guided photorefractive keratectomy. We chose to regularize the corneal surface instead of attempting to correct the refractive error, due to the great difference in the curvature and pachymetry in the two cornea halves. Her refraction 3 months post-op with -3.00 -1,50 x 80º was 0.18 logMAR.
Incomplete flap due to loss of suction is a rare LASIK complication. It has a very low incidence and is more likely to occur in flat corneas, deep orbits, inadequate suction and decentered ring placement.
If an incomplete flap is created, the surgeon should reposition the shredded flap as best as possible and do not proceed with the excimer laser. If the flap is lost, then topoguided PRK is a viable option with good results from the therapeutic point of view.
Cornea Day: Section 2: Complications after surgery and primary and secondary ectasia (EU Cornea)
18.02.2022 10:50
18.02.2022 12:00
2

CR15
LATE TRAUMATIC LASIK FLAP DISLOCATION: TWO CASE REPORTS
Victoria Segura Fernandez - Nogueras
Management of corneal complications after refractive surgery
Victoria

Segura Fernandez - Nogueras
Spain
Laser-assisted in-situ keratomileusis (LASIK) is one of the most common surgeries performed worldwide. Its efficacy, outcomes predictability, and safety have experienced a great development over the years but it is not exempt of intraoperative and postoperative risks. We aim to report two cases of late LASIK flap traumatic dislocation, and so review the management of this ocular emergency.
Department Of Ophthalmology of Universitary Hospital Virgen de la Victoria, Málaga (Spain).
Case 1: a 39 years-old female with myopic LASIK performed 5 years ago who hit her left eye (LE) with the cover of a book. Eleven days after the traumatism, she complained about intense pain and blurry vision, Snellen uncorrected distance visual acuity (UDVA) was 20/32 and corrected distance visual acuity (CDVA) was 20/25, refraction +1,25 -2,5X140º. The biomicroscopy revealed epithelial ingrowth (EIG) and flap-folds. Surgical management was decided, the procedure consisted of lifting the dislocated flap, debriding the EIG, flattening the flap and repositioning it with 10.0 Nylon sutures. After four months the CDVA was 20/20 in LE, residual refraction was +0 -0,5X 85º and no surface symptoms were reported.
Case 2: a 30 years-old man with myopic LASIK 10 years ago who suffered a blunt work trauma in his right eye (RE) three months before consulting. The Snellen UDVA was 20/400 and CDVA 20/32, the slit lamp examination showed several small foreign bodies (FB) and a central flap tear, with EIG. Surgery was proposed to lift the flap and remove the FB, however, the great friability of the flap made it no longer optically viable, so it was resected. After four months of follow up, UDVA 20/32 and CDVA 20/32, residual refraction -0,75 -1X 10º. Mild haze is still visible in the anterior corneal stroma.
Late flap dislocations are infrequent: from 0.012% to 2,5% according to the literature. An early evaluation by a refractive surgeon guarantees quick and correct surgical management making it possible to achieve good visual acuity and avoid further complications such as EIG and flap-folds.
Cornea Day: Section 2: Complications after surgery and primary and secondary ectasia (EU Cornea)
18.02.2022 10:50
18.02.2022 12:00
3

CR16
CALCIFIED SHIELD ULCER IN A KERATOCONIC EYE IN THE ABSENCE OF ALLERGIC OR ATOPIC KERATO-CONJUNCTIVITIS
Zahra Ashena
Ocular surface disease: what worked and what did not
Zahra

ASHENA
United Kingdom
Corneal shield ulcer is a known complication of Atopic kerato-conjunctivitis (AKC) or vernal kerato-conjunctivitis (VKC). It is believed that active inflammation may trigger adherence of a mucus layer to the corneal epithelial surface, which in turn can cause recurrent epithelial micro-erosion with subsequent deposition of calcium to the plaque. There is, however, no report of a corneal shield ulcer in the absence of AKC or VKC in the literature.
Queen's hospital, London, United Kingdom
37-year-old Caribbean male patient, with known keratoconus and history of corneal crosslinking 10 years before, presented with one month history of left eye discomfort, photosensitivity, and reduced vision. His right eye with a maximum keratometry of 79 D has had a long-standing poor vision and his left eye has been his good eye. He was intolerant to rigid gas permeable contact lenses (RGPCL) and lost to follow up for 10 years. His general health was good and denied any history of asthma, eczema, hay fever, itchy eyes or habitual eye rubbing in the past. His best spectacle visual acuity (BSCVA) was counting fingers in the right and 1.06 LogMar in the left eye. Examination showed a distinctive calcified shield ulcer affecting the paracentral region of his left cornea, in the absence of a corneal neovascularization, or any signs of allergic eye disease including limbal Horner-Trantas dots, or palpebral micro/macro-papillae. The calcific deposition was removed at the slit lamp, and he was started on low frequency topical preservative free antibiotics and Dexamethasone. However, he remained symptomatic with persistent epithelial defect, which was surrounded with residue of the plaque. Two weeks from presentation he was taken to the theatre for complete excision of the plaque residue, 360 degrees on the margin of the epithelial defect with a crescent blade, and insertion of a 11mm amniotic membrane disc and a bandage contact lens on the cornea. One week later, his eye was comfortable, and the amniotic membrane had partially disintegrated. Three weeks from surgical procedure, the corneal epithelium was nicely healed and the stroma showed no signs of scarring, and his unaided visual acuity was 0.66 LogMar, improving to 0.4 LogMar with pinhole. His Pentacam scan and anterior segment OCT showed a significant paracentral stromal thinning with subsequent epithelial hypertrophy. Three months from surgical excision of the plaque, his BSCVA is 0.5 LogMar in this eye.
Shield ulcer may occur in the absence of active inflammation. In our case, it seems that mechanical friction between the corneal apex and palpebral conjunctiva triggered the epithelial micro-erosion and calcium deposition to develop a calcific shield ulcer. Complete epithelial healing occurs with surgical debridement of the calcific plaque and insertion of an amniotic membrane.
Cornea Day: Section 2: Complications after surgery and primary and secondary ectasia (EU Cornea)
18.02.2022 10:50
18.02.2022 12:00
4

CR17
BELANTAMAB TOXICITY MIMICKING KERATOCONUS PROGRESSION
Francisco Javier Valentín-Bravo
Keratoconus management
Francisco Javier
Valentín
Bravo
Spain
To report belantamab mafotidin ocular toxicity as a cause of pseudo-progression in keratoconus
Belantamab Mafodotin, is a monoclonal antibody-drug conjugate developed for the treatment of relapsed multiple myeloma, demonstrating a clinical response. However, ocular toxicity, such as corneal microcyst-like epithelial changes (MECs) has been observed. This modifies anterior corneal profile by an epithelial thickening, mimicking an ectatic corneal progression when only anterior elevation corneal tomographic maps are used.
The aim is to emphasize the importance of considering the corneal posterior tomographic parameters assessment in the right evaluation of keratoconus.
Based on the patient´s clinical examinations and follow-up performed in Valladolid Clinical University Hospital, Spain.
A 62-year-old caucasian male with a history of multiple myeloma refractory to five lines of treatment, was referred for ophthalmic evaluation. He was previously diagnosed with keratoconus and after a complete ocular examination, it was decided to start belamaf.
Baseline ocular exam was significant for Fleischer ring, Vogt striae and subepithelial scarring in both eyes. His best corrected visual acuity (BCVA) with Snellen charts was 0.6 and 0.7 in the right eye (OD) and left eye (OS), respectively.
Ophthalmological follow-up examiantions were performed before each therapeutic cycle. Following the second dose, slit-lamp biomicroscopy revealed multiple bilateral MECs characterized as mild in the periphery and distributed more densely in the inferior cornea. Therapy was maintained looking for a response due to an aggressive form of myeloma.
After the third dose, his BCVA decreased to 0.3 in OU. MECs progressed centripetally and a whorl-like pattern was detected in both corneas. Additional symptoms of ocular discomfort were also experienced.
Corneal elevation tomography, performed with Galilei® G6, showed an increase in keratometric values, with a difference of more than 3 Dioptres (D) in the cone region comparing to the baseline values, what appeared to be a keratoconus progression. Examination showed a thickening in thinnest corneal pachymetry of 13 microns in OD and 17 microns in OS. However, there were no significant changes in posterior elevation corneal maps. AS-OCT confirmed the origin of the epithelium in these changes. These findings allowed to assume that MECs and epithelium changes were the main cause in these topographic changes.
The patient discontinued the treatment not only by his ocular events but also because of myeloma progression. Unfortunately, he passed away weeks later.
Belantamab is associated with significant ocular toxicity. All these changes are reversible when drug is stopped.
MECs caused by Belantamab may modify epithelial microstructure. These changes can origin modifications in corneal tomography which mimic keratoconus progression. Imaging of the posterior corneal surface by elevation topography scan is useful to differentiate a true progression.
Cornea Day: Section 2: Complications after surgery and primary and secondary ectasia (EU Cornea)
18.02.2022 10:50
18.02.2022 12:00
5

CR18
MANAGEMENT OF ACUTE CORNEAL HYDROPS WITH FULL-THICKNESS SUTURING, A CASE SERIES
Zahra Ashena
Keratoconus management
Zahra

ASHENA
United Kingdom
Acute corneal hydrops is a painful and visually debilitating complication of keratoconus. Interventions like intracameral air or gas injection with or without full-thickness compressive suture, pre-Descemet membrane suturing, and OCT-guided drainage of intra-stromal fluid have been introduced to accelerate the corneal oedema resolution and hasten visual recovery. We describe the clinical outcome of full-thickness corneal suturing as a solo treatment in management of acute corneal hydrops.
Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
Our series include five known keratoconus patients, consisting of four male and one female between 20 and 41 years of age, who presented with acute symptoms of unilateral ocular pain, blurred vision, photosensitivity and epiphora for 3 to 8 days. Visual acuity at presentation was counting fingers in two patients and hand movement in three patients. Conservative management with lubricants, topical antibiotics, and sodium chloride 5% eye drops started in the eye casualty. Two to five days from their presentation, the procedure was carried out in the theatre: a small air bubble was injected to the anterior chamber, which revealed the Descemet break/s within 10 minutes. This technique was particularly helpful in cases with extensive oedema, where the anterior segment OCT failed to demonstrate the Descemet break. This was followed by placing 3 to 6 full-thickness interrupted 10-0 nylon corneal sutures perpendicular to the Descemet break/s. The air bubble was removed at the end of the procedure. A complete resolution of corneal oedema and ocular discomfort was noticed within 10 days in four patients and 8 weeks in one atopic patient, who presented with extensive stromal oedema secondary to a large Descemet break and a corneal thickness of 1493 µ. Corneal sutures were removed 8 to 10 weeks from the procedure. Following treatment, the mean apex pachymetry reduced from 1225±215µ to 443±56µ and best corrected visual acuity (using rigid gas permeable contact lenses), was like pre-hydrops vision in four patients, and reduced by one line in the atopic patient whose visual axis was remarkably involved. None of the patients developed any complications.
Full-thickness corneal suturing perpendicular to the Descemet break as a solo treatment is a safe and efficient intervention to reduce the duration of morbidity and the risk of significant corneal scarring in the setting of acute corneal hydrops, and subsequently postpones the need for keratoplasty in this group of patients.
Cornea Day: Section 2: Complications after surgery and primary and secondary ectasia (EU Cornea)
18.02.2022 10:50
18.02.2022 12:00
6

CR19
THE CASE OF FEMTOSECOND LASER-ASSISTED NON-DESCEMET’S STRIPPING ENDOTHELIAL KERATOPLASTY AFTER FAILED PENETRATING KERATOPLASTY FOLLOWED WITH PHACOEMULSIFICATION AND TORIC INTRAOCULAR LENS IMPLANTATION
Ivan Tkachenko
Ocular surface disease: what worked and what did not
Ivan

Tkachenko
Russian Federation
To describe the staged process of visual rehabilitation of the patient having failed penetrating keratoplasty (PKP) due to endothelial dysfunction (ED) managed with femtosecond laser-assisted non-Descemet stripping endothelial keratoplasty (FS-nDSEK) first followed with phacoemulsification (PE) and hydrophobic toric intraocular lens (IOL) implantation as a secondary procedure
1.S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
2.A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia

A 49 years-old man with failed PKP graft and cataract presented to our clinic complaining the low vision of the left eye (LE). PKP was performed 10 years for keratoconus of the same eye. On admission, preoperative examination showed low BCVA - 0,005 on the LE. In right eye BCVA was 0,7. According to optical coherence tomography (OCT), the central corneal thickness (CCT) was 956 µm. No endothelial cell (EC) count was possible. As a first stage, the FS-nDSEK was done utilizing the LDV Z8 femtosecond laser (Ziemer, Switzerland) for graft preparation from the endothelial side. The hydroxypropyl methylcellulose (HPMC 1%) was applied to the endothelium prior to laser applanation. One week postoperatively the eye was quiet, the patient showed increase at BCVA and corneal edema decrease, BCVA increased up to 0,05. The CCT averaged 640 µm. Six months postoperatively the CCT averaged 535 µm. ECD was 1985 cells/mm2. Patient underwent a comprehensive ophthalmologic examination including refractometry, ocular biometry (IOL Master 700), corneal topography (Tomey, TMS-5), corneal tomography (Pentacam). Preoperative examination revealed regular with-the-rule LE corneal astigmatism. According to tomography (Pentacam) corneal curvature was 43.7 axis 156.9° and 46.6 axis 66.9°. The data of Pentacam and IOL-Master correlated with each other. The target postoperative refraction was set at –0.50D spherical equivalent (SE). 6 months after FS-nDSEK, PE combined with a toric IOL implantation was performed. First day postoperatively the eye was quiet, the patient showed increase of BCVA with reduction in the manifest astigmatism. BCVA was 0,8 with SE -0,5D. The CCT averaged 551 um. 12 months postop FS-nDSEK and six-month postop PE+IOL UCVA and BCVA were 0.7 and 0.8, respectively, with SE -0.75D. The CCT averaged 580 µm and ECD 1372 cells/mm2.
FS-nDSEK is an effective method for the treatment of ED of failed PKP graft, which allows to achieve resorption of edema in the early postoperative period and to reduce the risk of graft rejection. A two-stage treatment strategy was chosen to correct postkeratoplasty astigmatism and achieve high functional results. Endothelial viscoprotection at the applanation stage made it possible to reduce intraoperative endothelial loss and thereby ensure a fairly high percentage of EC survival in the late postoperative periods. At 6- and 12-months postoperative periods corneal EC loss was 28% and 50% respectively.
Cornea Day: Section 2: Complications after surgery and primary and secondary ectasia (EU Cornea)
18.02.2022 10:50
18.02.2022 12:00
7

CR20
GLUELESS SIMPLE LIMBAL EPITHELIUM TRANSPLANTATION (G-SLET) WITH FEMTOSECOND LASER ASSISTANCE IN PATIENT WITH UNILATERAL CHEMICAL BURN.
Svetlana Yryevna Kalinnikova
Ocular surface disease: what worked and what did not
Svetlana

Kalinnikova
Russian Federation
To describe the technique and results of G-SLET with femtosecond laser intracorneal tunnels for autologous limbal pieces fixation in patient with unilateral partial limbal stem cell deficiency following ocular surface burn.
1. The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow
2. A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
3. Ziemmer Opthalmic Systems AG, Switzerland
A 35-year-old woman was referred to out clinic with partial (120 degrees) limbal stem cell deficiency (LSCD) on the right eye (RE) as a late complication after accidental household ocular burn with a lime acid 10 years ago. The patient was complaining for low vision on her RE (0.1 decimal), epiphora and photophobia. No other local or systemic comorbidities were found. The surgery included the G-SLET with corneal tunnels were created with femtosecond laser LDV Z8 (Ziemer, Switzerland) using custom algorithm and trajectories. We used 8 radially orientated pockets with the depth of 300 μm. Pockets we used to fixate small pieces of limbal tissue harvested from the healthy eye of the same patient. Postoperative period was uneventful. BCVA for RE gradually improved up to 0.6 (decimal) 6 months postop. Slit-lamp biomicroscopy demonstrated full reepithelization of the cornea, and light punctate fluorescein staining. Right eye AS-OCT demonstrated normal cornea epithelial map. The patient noted a decrease in subjective complains. The biopsy site on the healthy eye was well covered with conjunctiva. After 3 months all limbal micro-transplants were visible inside the corneal tunnels.
The novel G-SLET technique with femto-assistance promotes precise formation of the corneal stromal tunnels with pre-determined location and uniform depth. This ensures the predictability of the tunnel formation step, as well as minimizes intraoperative risks, such as corneal perforation. In our case, complete corneal epithelialization was achieved in an early postop period. VA significantly increased, and subjective complaints were substantially decreased. The FS_G-SLET is a novel surgical method that can be used in the treatment of unilateral limbal stem cell deficiency at the stage of tunnel formation.
Financial Disclosure of all authors: Bernau W. and Müller F. are employed by Ziemer Group. Other authors have no a financial or proprietary interest in any material or method mentioned.
Cornea Day: Section 3: Ocular surface (ESCRS)
18.02.2022 13:30
18.02.2022 15:30
1

CR21
UNILATERAL OCULAR CICATRICIAL PEMPHIGOID SECONDARY TO LEVAMISOL-ADULTERED COCAINE CONSUMPTION
June Artaechevarria Artieda
Ocular surface disease: what worked and what did not
June

ARTAECHEVARRIA ARTIEDA
Spain
To describe the clinical findings and management of a unilateral ocular cicatricial pemphigoid (OCP) secondary to Levamisol-adultered cocaine consumption.
Referral hospital Fundación Jiménez DÍaz
A 48-year-old woman consulted for left eye (LE) vision loss and oral ulcers for the last 6 months. She referred inhaled cocaine consumption through her left nasal fossae. On examination, best corrected visual acuity (BCVA) was 1.0 logMAR in her right eye (RE) and hand movement in LE. The slit-lamp biomicroscopy showed a complete corneal conjunctivalization, shortening of the fornices, temporal symblepharon, cicatricial entropion of the superior eyelid eyelashes with the cornea causing a temporal epithelial defect. Anterior chamber was preserved. On sytemic examination, a well delimited diffuse lingual ulcer that respected the base and the tip of the tongue was found. No other dermatological lesions were observed. A complete blood analysis was performed to rule out infectious or autoinmune diseases. The conjunctival biopsy showed intersticial linfocite inflammation and was negative for direct immunofluorescence (DIF). The oral biopsy showed acute and chronic inflamation and DIF yielded a linear IgA deposit along the epithelium basal membrane. The indirect immunofluorescence (IIF) detected high circulating IgA levels. <span class='BCX4 SCXW217949073 SpellingErrorV2 NormalTextRun' style='te
OCP is a chronic cicatricial disease affecting mucous membranes and skin, which can lead to ankyloblepharon in severe cases. It is an autoimmune response caused by an environmental trigger which leads to inflammation and scarring, in this case the levamisol-adultered cocaine. DIF of conjunctival or oral mucous biopsy is the gold standard to confirm the diagnosis, showing a linear deposition of IgG, IgA, IgM and complement 3 proteins in the epithelial basement membrane. A multidisciplinar management is essential to control the inflammation and halt the progression. Topical treatments alleviate symptoms but only systemic immunosupression stops progression. Surgical interventions can be employed as adjunctive therapy to treat complications.
Cornea Day: Section 3: Ocular surface (ESCRS)
18.02.2022 13:30
18.02.2022 15:30
2

CR22
SIMPLE LIMBAL EPITHELIAL TRANSPLANT (SLET) FOR OCULAR SURFACE RECONSTRUCTION FOLLOWING THERMAL INJURY
Ahmed Ali
Ocular surface disease: what worked and what did not
Sathish

Srinivasan
United Kingdom
To report the clinical features, surgical technique and outcome following simple limbal epithelial transplant (SLET) in a patient with prior thermal injury with limbal ischaemia.
Department of Ophthalmology, University Hospital Ayr, Ayr, Scotland, UK
49 year old Caucasian male with no prior ocular history attended the corneal clinic in March 2020 following an assault. • Mixture of hot water and sugar was thrown over face resulting in ocular thermal injury. • Visual acuity at presentation was hand movements in the injured left eye and 6/7.5 (Snellen)(LogMAR 0.1) in the right eye, with normal intraocular pressures bilaterally. • Examination revealed superficial peri-ocular skin burn and ocular surface injury. • A degree of limbal ischaemia was suspected due to associated chemosis and the 100% corneal epithelial defect. • Management: preservative-free Dexamethasone and Chloramphenicol • Per Oral Doxycycline and Vitamin C tablets. Compliance issues with the prescribed drops over the following months. • 3 months post-injury: central corneal epithelial defect and 360 degrees of corneal neovascularization. •Visual acuity: hand movements. •6 months post-injury: severe secondary corneal neovascularization, chronic epithelial defect and limbal stem cell deficiency (LSCD) Patient underwent simple limbal epithelial transplant
•SLET is a more convenient treatment option in comparison to earlier techniques for the management of unilateral LSCD. •Particularly effective in patients with chemical or thermal injuries. In this case SLET resulted in restoring the ocular surface anatomy.
Cornea Day: Section 3: Ocular surface (ESCRS)
18.02.2022 13:30
18.02.2022 15:30
3

CR23
MANAGEMENT OF SEVERE OCULAR SURFACE ALTERATIONS WITH PILLAR TARSOCONJUNCTIVAL FLAP
Francisco Zamorano Martín
Ocular surface disease: what worked and what did not
Francisco

Zamorano Martín
Spain
To evaluate the effectiveness of the surgical procedure of the pillar tarsoconjunctival flap (PTCF) in severe ocular alterations of the ocular surface refractory to conventional treatments.
Retrospective cohort study of two patients who underwent a PTCF. The first one had neurotrophic keratitis and the second one, exposure keratopathy. Both cases had satisfactory results after surgery, showing total corneal re-epithelization that lasted the entire follow-up (mean 8 months). The mean time to re-epithelization was 5.5 days.
Case 1. A 44-year-old male with recurrent stromal herpetic keratitis. After resolution of the last episode, a paracentral persistent epithelial defect (PED) (4 x 2 mm) with an area of thinning remained. The patient referred great dysesthesia and photophobia and did not tolerate a bondage contact lens (BCL). After two months of unsuccessful treatment with artificial tears (AT), autologous serum (AS) and topical antibiotics, a PTCF was performed. After four days the symptoms had greatly improved, the epithelial defect healed and remained stable after six months of follow-up.
Case 2. An 80-year-old male after resection of a lower eyelid tumour covered with a skin flap developed an exposure keratopathy (EK) followed by a PED. Treatment with AT, AS and topic antibiotics proved to be unsuccessful because of the absence of the inferior part of the orbicular muscle. Despite three months of intensive topical treatment, further progression of the PED with stromal thinning was observed. A PTCF was performed to reduce the effect of increased exposure due to poor orbicularis function secondary to the resection. A wet-chamber patch was added at night due to incomplete interpalpebral fissure closure. One week after the surgery the epithelial defect closed and the thinning healed, remaining stable after 12 months.
The PFTC is a valid alternative to tarsorrhaphy, counting as main advantages the preservation of vision, lower risk of infectious keratitis, the possibility of examining the eye during the healing process and allowing the phenomenon of blinking. Its indications would be: neurotrophic keratopathy, exposure keratopathy and corneal melting.
Cornea Day: Section 3: Ocular surface (ESCRS)
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4

CR24
NEW PROMISING THERAPEUTIC APPROACH FOR REFRACTORY PERSISTENT EPITHELIAL DEFECTS: A CASE REPORT
Rodrigo Vilares Morgado
Ocular surface disease: what worked and what did not
Rodrigo

Vilares Morgado
Portugal
Persistent corneal epithelial defects are unable to heal within the usual two-week time span, generally develop in the setting of significant ocular surface disorders and are frequently resistant to conventional therapies. Recently, a custom-designed, gas permeable, fluid-ventilated scleral lens, the PROSE device, has been used as an effective therapy in refractory cases, typically during the daytime. However, the elevated costs and need for specialized manufacture equipment make its use unpracticable in a public health setting. The purpose of this case report is to describe a case of continuous wear of a gas-permeable mini scleral contact lens with a fluid reservoir of autologous serum combined with autologous serum drops, as a successful empirical and accessible alternative therapeutic option for persistent epithelial defects.
Clinical case report of a patient followed in the Ophthalmology Department of Centro Hospitalar Universitário S. João.
A 61-year-old woman with severe dry eye disease and bilateral neurotrophic keratopathy of uncertain etiology, had been followed by cornea specialists from our hospital since 2002. Her past ophthalmological history included 3 penetrating keratoplasties in the left eye (in 2003, 2010 and 2016) and multiple episodes of bilateral persistent epithelial defects over the years, that ultimately responded to conventional treatment. In 2017, the patient developed a refractory neurotrophic ulcer in the right eye, complicated 1 year later with fungal and subsequent bacterial infection and finally managed with a therapeutic penetrating keratoplasty, performed in October 2018. Nevertheless, 2 months later, the patient developed a 6x6mm persistent epithelial defect unresponsive to all traditional therapeutic strategies, including artificial tears and ointments, bandage soft contact lens, autologous serum drops, topical antibiotics, oral tetracyclines, cacicol®-RGTA and nerve growth factors. After months of unsuccessful treatments, we decided to empirically try the use of a gas-permeable mini scleral contact lens with a fluid reservoir of autologous serum in combination with hourly autologous serum drops. The lens was worn continuously for 48h, being removed only for cleaning and replacing the fluid reservoir with new autologous serum. After 2 weeks, the corneal epithelium eventually started to regenerate, and 4 weeks later the cornea was completely epithelized. The continuous usage was then reduced to a 24h period, and there are no signs of recurrence of the epithelial defect, thus far.
This case highlights the potential value of continuous wear of a gas-permeable scleral contact lens combined with autologous serum drops, as a novel and promising alternative approach to conventional treatments for refractory persistent epithelial defects. Notwithstanding, our clinical experience with this empirical approach remains limited and further investigation is required to clinically validate this therapeutic option.
Cornea Day: Section 3: Ocular surface (ESCRS)
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5

CR25
THE IMPORTANCE OF CORNEAL ANGIOGRAPHY IN SUBCLINICAL LIMBITIS IN A CASE OF ATOPIC KERTOCONJUNCTIVITIS
Davide Romano
Ocular surface disease: what worked and what did not
Davide

Romano
Italy
To report corneal angiography features in subclinical limbitis in a patient with atopic kertoconjunctivitis
Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital.
A 22-year-old woman was referred for bilateral corneal neovascularization with scarring. Her past medical history was positive for erythema nodous and atopy, as she had been diagnosed with eczema, asthma, hay fever, dust allergy, and atopic keratoconjunctivitis (AKC). She had a past ocular history negative for herpetic keratouveitis, trauma, infections, or use of contact lenses. She was on topical tacrolimus 0.03% ointment twice daily, oral antihistaminic (Cetirizine 10 mg once daily), and occasional courses of eye drops of olopatadine 0.1% and prednisolone 1%, which have been used discontinuously in the past.
On examination, the best corrected visual acuity (BCVA) was 20/40 in the right eye (RE) and less than 20/200 in the left eye (LE), while the intraocular pressure was 18 mmHg in RE and 8 mmHg in LE.
At slit lamp examination, the AKC was inactive, and the patient complained only of non-specific discomfort and occasional itchiness. No mucoid discharge, no bulbar conjunctiva hyperemia nor punctate keratitis were present.
Of note was the bilateral corneal pannus with superficial and deep corneal neovascularization (CoNV) and scarring in both eyes. The state of activity of the corneal pannus was uncertain, as no signs of oedema and leakage were noticeable at biomicroscopy.
To better estimate the possible presence of subclinical ocular surface inflammation activity, the CoNV status, and to plan suitable therapy and monitoring, an anterior segment fluorescein angiography (FA) and indocyanine green angiography (ICGA) were performed. The FA showed limbal leakage at the early phase (around 1 minute after injection), and ICGA dye leakage in the late phase (5-10 minutes after the injection), more pronounced in the left eye and in the superior hemi-cornea. These findings highlighted a subclinical inflammation of the limbus. Late leakage of corneal vessels was also noticed at FA and ICGA.
The patient was recommended to continue treatment with tacrolimus 0.03% ointment twice daily and in both eyes start topical dexamethasone 0.1% six times per day, as well as topical olopatadine 0.1% twice daily, for 8 weeks.
At review, the patient reported feeling better, with less ocular discomfort. The BCVA remained stable and, at slit lamp, the ocular surface appeared unchanged. Limbal FA and ICGA leakage was no longer present, proving the efficacy of the treatment.
Active allergic corneal limbitis may present as subclinical inflammation, with no signs of activity at slit-lamp examination. Therefore, its diagnosis can be challenging without the use of corneal angiography.
Cornea Day: Section 3: Ocular surface (ESCRS)
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6

CR26
PRIMARY ACQUIRED MELANOSIS ASSOCIATED WITH MYCOSIS FUNGOIDES , A CASE REPORT
Mofi Alwalmany
Ocular surface disease: what worked and what did not
Mofi

alwalmany
Saudi Arabia
To report a 1st assosiation of Mycosis Fungoides with Primery Acquied melanosis .
Mucosa associated lymphoid tissue ( MALT ) is the most common lymphoproliferative tumors involving the eye and adnexa . Where Mycosis fungoides ( MF ) which is a proliferation of helper T lymphocyte is rarely present with ophthalmic presentation only in 2% with the eyelid being the most common site of involvement as eyelid ectropion . Here in our case we present a rare case of primary acquired melanosis ( PAM ) present with MF , diagnosis of PAM was made after full surgical excision of the pigmented lesion in the conjunctiva which was sent for histopathology study , where diagnosis of PAM without atypia was made. Up to our knowledge, This is the first reported case of PAM associated with MF
A 33-year-old male known case of mycosis fungoides was diagnosed three years back when he started developing hyperpigmented cutaneous patches over the trunk and extremities. The patient received several sessions of phototherapy and methotrexate.
The patient was referred to the ophthalmology department due to the patient's concern about abnormal localized pigmentation of the left eye that was noticed during the time of skin lesions development. This abnormality did not change in size or pigmentation.
Upon examination, his visual acuity measured in Decimal was 1.0 (20/20) right eye (OD), and 0.5 (20/40) left eye (OS). Slit-lamp examination revealed Left homogenously pigmented conjunctival. The lesion was flat, mobile, and involving the interpalpebral bulbar conjunctiva near the limbus. It measured around 7mm by 5mm . Also, another similar small lesion was found in the conjunctiva of the left eye and the right eye. No palpebral or forniceal conjunctival involvement. No leukoplakic feature was seen. Cornea, iris, and lens were within normal limits in both eyes. Posterior segment evaluation was insignificant.
The patient underwent surgical excision with a safe margin. Histological diagnosis of primary acquired melanosis (PAM) without atypia ( C-MIN score 1/10 ) was made . The decision of observation with regular follow-up was made. The patient was advised to come back immediately whenever any new abnormality or recurrence occurs.
This case revealed a 1st association of PAM with MF patient , as we see in this case where a PAM without a atypia developed in the conjunctiva at the same time when MF was diagnosed
Cornea Day: Section 3: Ocular surface (ESCRS)
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7

CR27
A CASE OF OCULAR SURFACE RECONSTRUCTION IN A CHILD WITH UNILATERAL LIMBAL STEM CELL DEFICIENCY AND ENTROPION AFTER FIRECRACKER INJURY
Maksim Yu. Gerasimov
Ocular surface disease: what worked and what did not
Maksim
Yu.
Gerasimov
Russian Federation
To describe a clinical course of a pediatric patient treated by entropion repair and glueless simple limbal epithelium transplantation (G-SLET) for ocular surface reconstruction and preventing amblyopia development.
The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
A 7-year-old girl was presented in the clinic with partial (5 hours/150 deg) unilateral limbal stem cell deficiency (LSCD) and lower eyelid entropion on left eye (LE) after an accidental firecracker injury in Dec 2019. Before the injury, she was emmetropic with UCVA 1.0 OU. At first, the entropion repair with oral mucosa grafting was done in the oculoplastic department. However, despite the success of the surgery and little involvement of the LE central cornea, the patient developed mixed astigmatism six months later. Her refraction was +0,5D for RE and -12.25D for LE and BCVA on LE decreased to 0,08 (decimal values). Anterior segment optical coherent tomography (AS-OCT) OS demonstrated progression of conjunctivalisation and subepithelial fibrosis to the central cornea as well as an irregular corneal epithelial map. G-SLET on LE was done with five limbal auto-transplants inserted into the corneal tunnels. During the first postop month, patient had an intensive irritation LE which gradually decreased on steroid and fourth-generation fluoroquinolone ointments. Additionally, occlusion therapy for LE was recommended for one hour per day for 3 months. At one month postop here BCVA on LE was 0.6 with SE +1.25D. The LE cornea was fully epithelized with light punctate fluorescein staining. The biopsy site on RE healed with a light scar and was surrounded with light local conjunctival hyperemia. At three-month postop UCVA and BCVA on LE were 0.4 and 0.7, respectively, with SE -0.25D. The cornea LE was fully epithelized and had no staining. An eyeglass was prescribed for ametropia correction for permanent use. At twelve-month postop (last appointment) UCVA and BCVA on LE were 0.4 and 0.7, respectively, with SE -0.625D. The cornea LE was fully epithelized and had no staining. AS-OCT LE demonstrated a normal cornea epithelial map and absence of subepithelial fibrosis in the central cornea. The biopsy site on RE at three- and twelve months postop was invariable.
Partial LSCD, as a complication of burn eye injury, could induce corneal astigmatism and contribute to the development of amblyopia in children. G-SLET was effective in the elimination of conjunctivalization in the central cornea. Occlusion therapy after G-SLET promoted improvement in UCVA and BCVA in the injured eye.
Cornea Day: Section 3: Ocular surface (ESCRS)
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18.02.2022 15:30
8

CR28
COMBINED LIMBAL STEM CELL WITH AMNIOTIC MEMBRANE GRAFT TRANSPLANTATION FOR CHEMICAL BURN PATIENT
Karim Elmowafi
Ocular surface disease: what worked and what did not
Karim

ELMOWAFI
Egypt
The aim of this study is Evaluation role of combined limbal stem cell with amniotic membrane graft transplantation for chemical burn and thinning by assessment of healing of corneal epithelium, increased corneal thickness in case with corneal thinning by using slit lamp bio microscopy and anterior segment optical coherence tomography. Moreover, BCVA before and after procedure monitoring
The patient underwent a biopsy of the limbus from the fellow eye; the biopsy material was cultivated on fibrin, a natural substrate that preserves holoclone-forming cells. (Mansoura ophthalmic center, Mansoura university, Egypt) The fibrin-cultured epithelial sheet has been grafted over the corneal and limbal region of the injured eye, where the receiving bed had been previously surgically prepared. A 360° peritomy was performedand the fibrovascular pannus was carefully removed. The fibrin-cultured epithelial sheet was placed on the prepared corneal wound bed, spanning the limbus about 2–3 mm with conjunctival ingrowth.The amniotic membrane was then sutured over the peripheral fibrin sheet and the whole cornea with in order to protect the border of the sheet and to help it adhere on the corneal surface
A 50-year-old man with a 21-year history of chemical burn of the cornea caused by phosphoric acid in his left eye presented to our hospital with unilateral total LSCD, severe corneal conjunctivalization, cataract, and a corrected distance visual acuity (CDVA) limited to hand motion in the affected eye. After, combined limbal stem cell with amniotic membrane transplantation for the patient's eye. The preoperative CDVA was limited to hand motion. Five days after the autologous LSC combined with amniotic membrane transplantation. The corneal surface became regular and transparent. Renewal of the corneal epithelium appeared within the first week after transplantation. Two weeks after surgery, the patient's best corrected visual acuity was 20/50. After 30 days from transplantation, we observed almost complete corneal epithelium renewal, a regression of peripheral edema.
Several surgical procedures have been proposed for the treatment of chemical burn patients with LSCD in order to restore the limbal stem cell reservoir. After more than 50 years of trials, no consensus on guidelines for the management of this challenging condition has been reached. This is mainly due to heterogeneity of patient population, different follow-up periods, and outcomes, used in the clinical studies. In fact, while improvement of quality of life, visual acuity, or ocular surface may be considered a clinical success, to define a success of LSCT is necessary to combined it with amniotic membrane transplantation specifically in patients presented by Chemical burn with large corneal epithelial defect. Recently, umbilical cord patching is a promising alternative procedure which could be used in management of corneal surface reconstruction in acute chemical burn with corneal perforation.
Cornea Day: Section 3: Ocular surface (ESCRS)
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9

CR29
OCULAR SURFACE COMPLICATIONS IN THE COURSE OF ECTRODACTYLY-ECTODERMAL DYSPLASIA-CLEFT LIP AND PALATE SYNDROME
Ewa Mrukwa-Kominek
Ocular surface disease: what worked and what did not
Ewa

Mrukwa-Kominek
Poland
Erodactyly-ectodermal dysplasia-cleft lip and palate syndrome (EEC) is a rare type of ectodermal dysplasia which is inherited in autosomal dominant pattern. Clinical presentation is characterised by a triad: ectrodactyly, ectodermal dysplasia and cleft lip and palate. Ophthalmic manifestation of the disease frequently leads to vision loss. Most common ocular manifestations are: obstruction of lacrimal drainage, corneal stem cells deficiency, impaired corneal regeneration, predisposition to corneal neovascularisation and also common inflammation of anterior segment of the eye. Authors present a case patient with EEC presenting corneal complications and the way to have a therapeutic success.
Department of Ophthalmology, Professor Gibinski's University Clinical Centre. Medical University of Silesia in Katowice, Poland
35 years old woman with diagnosed EEC was referred to our department for consultation because of deteriorating condition of cornea of the both eyes. She had already undergone corneal micro-transplant in march 2020 in another department of ophthalmology because of the perforation of the cornea in the course of ulceration.
On a visit she presented BCVA of the right eye 0,4, left eye no light perception. Slit lamp examination revealed in the right eye- corneal keratopathy with opacification in the stroma, neovascularisation of the cornea, fundus- without abnormalities. In the left eye microtransplant of the cornea, sutures maintained, neovascularization of cornea, anterior synechiae, fundus not visible in examination.
Additional ophthalmic examinations were done. Tear break up time was 2 seconds for the right eye and 3 seconds for left one. Ultrasound biomicroscopy of the left eye showed anterior synechiae and postinflammatory conglomerates in the anterior chamber and behind the iris. Confocal microscopy of the cornea of the right eye showed collagen overproduction and scarring in the anterior stroma.
We introduced pharmacological therapy including topical steroids, lubricating eyedrops and regenerating ointments. We obtained improvement of the visual acuity of the right eye to 0,7. Special modification of the therapy was the way to have a therapeutic success. Currently patient has regular follow-ups and her ophthalmic condition is stable.
Corneal complications in the course of EEC can be sight threatening as it happened in our patient's left eye. Therefore special attention should be given to provide intensive therapy and regular ophthalmological examination
Cornea Day: Section 3: Ocular surface (ESCRS)
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10

CR30
PERIPHERAL ULCERATIVE KERATITIS (PUK) IN RHEUMATOID ARTHRITIS
Oujidi Wissale
Ocular surface disease: what worked and what did not
Oujidi

Wissale
Morocco
Peripheral ulcerative keratitis or Mooren's pseudo-ulcers is a corneal manifestation of a general pathology affecting the small vessels.(1) Its treatment is determined by the severity of the corneal damage and the activity of the vasculitis. (2) We report the case of a woman who presented with rheumatoid arthritis complicated by peripheral ulceration and who responded well to treatment. (2)(3)(4)
Peripheral PUK corneal ulcers in autoimmune diseases are similar to Moran's ulcers in all respects. They are the corneal manifestation of a general pathology affecting the small vessels: vasculitis. The periphery of the cornea, limbus, includes a terminal vascularization. This is the source of inflammatory cell infiltration and a preferred site for the deposition of circulating immune complexes. (6)(7)(8) .Peripheral ulcerative keratitis (PUK) is a rare and is associated with high mortality. P(PUK) manifests as eye pain, redness, photophobia, and thinning and opacity of the peripheral cornea. The most serious complications are perforation and vision loss.treatment of PUK begins with topical corticosteroid therapy. If there is resistance to corticosteroids ,Systemic treatment is usually considered, including high-dose corticosteroid therapy and treatment with immunosuppressive agents or biotherapy. (5) The use of adhesive fabrics and therapeutic lenses can prevent of corneal melting. multilayer amniotic membrane grafting takes a large place. (9)(3)
82 year old female patient, followed for 15 years for rheumatoid arthritis.The patient presented since one week of her admission with a painful red eye with visual acuity decrease. The ophthalmological examination objectives: Visual acuity of 2/10 in the left eye. Biomicroscopic examination showed a clean, preperforative,marginal corneal ulcer of the left eye with peripheral neovascularization . The bacteriological sample was normal. Patient initially put on : Healing treatment based on artificial tears, preventive local antibiotic coverage, and under corticoid eye drops initially then under conjunctival injection of corticoid, with installation of therapeutic lens aimed at analgesia. The patient was put on a full dose of oral corticosteroids.The evolution was marked by a decrease in redness and ocular pain, with the beginning of healing of the ulceration after the 2nd subconjunctival injection.

Detection of corneal complications in inflammatory diseases is a factor in poor prognosis, especially in the case of ulcers. Sterile corneal ulcers are rare but can be a serious complication of rheumatoid arthritis. Our study illustrates a case that responded well to corticosteroid therapy. this Case confirmed the literature findings on the efficacy of corticosteroids in the treatment of corneal ulcers secondary to peripheral ulcerative keratitis in rheumatoid arthritis.
Cornea Day: Section 3: Ocular surface (ESCRS)
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11

CR31
READY TO USE TOPICAL INSULIN FOR A CASE OF REFRACTORY PERSISTENT EPITHELIAL DEFECT AFTER OCULAR SURGERY
Catarina Cunha Ferreira
Ocular surface disease: what worked and what did not
Catarina
Cunha
Ferreira
Portugal
To report the case of a patient with a central persistent epithelial defect (PED) after ocular surgery, refractory to standard medical therapy, treated safely and successfully with topical insulin.
Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
A 78-year-old man presented at the ophthalmology outpatient clinic with blurred vision in the left eye (LE) for two weeks. He reported no ocular discomfort or pain. The patient had a history of an uneventful cataract surgery in the LE one month prior and was under topical antibiotic, non-steroid anti-inflammatory, and corticosteroid therapy. LE best-corrected visual acuity was counting fingers and intraocular pressure was normal. Biomicroscopy of the LE revealed an asymptomatic 5 × 5 mm central epithelial defect with ulceration. Treatment with intensive lubrication, prophylactic topical antibiotic, and a bandage contact lens was initiated, and epitheliotoxic medication was withdrawn. At 2-weeks of follow-up, the patient maintained a central epithelial defect and minimal improvement, despite the optimized medical therapy. A decision was made to initiate off-label ophthalmic insulin eye drops (1IU/mL in a propylene glycol base), applied 4 times daily. Prophylactic topical antibiotic and a bandage contact lens were applied concomitantly. Close follow‐up of the patient was assured with visits every two days in the first week and weekly thereafter. Anterior segment photos were taken in each visit. Central PED resolved 7-days after initiating topical insulin and symptoms improved significantly. Insulin eye drops were slowly tapered, and the bandage contact lens removed, with intact epithelium and no PED recurrence.
Despite the wide range of therapeutic options, PEDs management and treatment often represents a challenge in daily clinical practice. When left untreated or if reepithelization does not occur, severe complications may develop including infection, perforation, and scarring. Topical insulin has been found to aid in corneal wound healing by enhancing proliferation of corneal epithelial cells, being useful in persistant epithelial defects refractory to initial therapy. Additionally, insulin is a relatively inexpensive and widely available drug whose safety has already been established as a topical treatment. In this case report, we demonstrate insulin eye drops therapeutic and cost-effectiveness for refractory PED after ocular surgery treatment in real-world clinical practice.
Cornea Day: Section 3: Ocular surface (ESCRS)
18.02.2022 13:30
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12

CR32
USAGE OF CICLOSPORIN EYE DROPS IN PEDIATRIC AGE: CASE REPORTS
Catarina Pestana Aguiar
Ocular surface disease: what worked and what did not
Catarina
Pestana
AGUIAR
Portugal
To report the usage of ciclosporin eye drops 1 mg/ml in the pediatric population with the diagnosis of vernal keratoconjunctivitis (VKC) who showed a lack of disease control with other treatments.
VKC is a severe form of ocular allergic conjunctivitis affecting predominantly children.(1, 2) This pathology has a significant impact on their daily activities, often leading to a decrease on school performance. The main symptoms are eyes redness, ocular itching, discharge, tearing and photophobia; and clinically we can observe conjunctival hyperemia, conjunctival papillae, Horner-Trantas dots and keratitis.(1) Considering the disease's impact, all efforts to improve the quality of life must be done. The usage of immunomodulatory agents such as topical ciclosporin is effective in the long-term treatment, since it is corticosteroid sparing in steroid-dependent patients when other treatments have failed.(3) In Portugal, the commercialized ciclosporin (Ikervis®) is only approved for administration in adults.(4) However, its off-label usage in the pediatric population has shown great benefits.

Case Report 1: A 6-year-old boy accompanied during the past 4 years due to VKC, very incapacitant, with intense itching and photophobia. He had also a history of atopic dermatitis and several bronchiolitis. When he presented to us in 2017, he had exuberant conjunctival papillae, conjunctival hyperemia and a superficial punctate keratitis with neovascularization. Since then, multiple cycles involving anti-inflammatory therapy, including corticosteroids, and ocular lubricants were performed, with a relapse every time corticosteroids were abandoned. Only in the being of 2021, when the ciclosporin was introduced, were he able to achieve partial remission and control of his disease.
Case Report 2: 7-year-old girl with a history of rhinitis, asthma and allergies, evaluated in 2018 for palpebral edema, eye redness and ocular itching. She had conjunctival hyperemia and papillae, blepharitis and Horner-Trantas dots. She was treated with tobramycin + dexamethasone and ketotifen with significant improvement. However, she came back about a year later complaining about recurrent eye redness and itching during this period. At this moment, besides the previous signs, she also had a superficial punctate keratitis. She was submitted to various cycles of treatment, which included corticosteroids, with relapse of the disease when they were stopped. Similarly to the previous case, there was only a sustained improvement when the ciclosporin was introduce, with total remission. They were both forwarded to a pediatrician specialized in allergies to study them systemically.
In pediatric patients presenting with corticosteroid dependent VKC the ciclosporin can be a helpful ally in the disease control, avoiding chronic usage of corticosteroids and providing a significant improvement of the clinical status and quality of life of these patients.(3)
Cornea Day: Section 3: Ocular surface (ESCRS)
18.02.2022 13:30
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13

CR33
KERATOPROSTHETICS TECHNOLOGY USING A FEMTOSECOND LASER
Olga Nefedova
Ocular surface disease: what worked and what did not
Olga

NEFEDOVA
Russian Federation
To assess the use of a femtosecond laser for keratoprosthetis implantation in combination with a penetrating keratoplasty.
The S. Fyodorov Eye Microsurgery Federal State Institution
We present a keratoprosthesis operation with a Fyodorov-Zuev keratoprosthesis in the only eye of a 43 year old patient with bilateral chemical burns of the cornea. Due to the uneven surface of the damaged vascularized cornea with areas of thinning in the central zone, it has been decided to transplant a corneal-prosthetic complex, which is a penetrating donor corneal graft with an implanted titanium keratoprosthesis supporting plate (KSP). At the stage of preparation of the corneal-prosthetic complex, both the pocket for implantation and the transplant of the donor cornea have been cut using the low-energy femtosecond laser Femto LDV Z8 (Ziemer Ophthalmic Systems, Switzerland). A KSP was implantend into the formed pocket. The resulting corneal-prosthetic complex was transplanted to the patient eye. According to our observations, the use of a femtosecond laser for the donor preparation facilitates the formation of a corneal-prosthetic complex, in contrast to the standard technique performed with microsurgical instruments. The femtosecond laser allows to form the pocket for the KSP precisely, with the required depth, width, and length. This enables stable positioning of the KSP inside the cornea, thus reducing the risk of protrusion of the KSP. No tissue bridges inside the pocket area have been observed. The laser operating time was 2 minutes 53 seconds, in contrast to the traditional method of forming a pocket using microsurgical instruments, which averages to 30 minutes.
The femtosecond laser allows to achieve a predictable and accurate formation of a corneal-prosthetic complex, allows for efficient and reproducible donor graft preparation, and for a stable positioning of the KSP inside the corneal-prosthetic complex.
Cornea Day: Section 4: Keratoplasty (ESCRS)
18.02.2022 15:30
18.02.2022 16:40
1

CR34
CLINICAL CASE OF THE USE OF THERAPEUTIC PLASMAPHERESIS TO PREVENT CORNEAL GRAFT IMMUNE REJECTION IN A PATIENT PRIOR TO HIGH-RISK KERATOPLASTY
Victoria Myasnikova
Keratoconus management
Viktoria

Myasnikova
Russian Federation
We give an example of a complex preoperative preparation of the patient before keratoplasty. The purpose of our case report is to demonstrate the effectiveness of plasmapheresis in the preoperative period in patients undergoing keratoplasty.
This clinical case was followed at The S Fyodorov Eye Microsurgery Federal State Institution - Krasnodar, Russia

On 15.07.2020, patient G., 56 years old, received a thermal burn in his right eye while starting a campfire, the same year cement got into his right eye. He was treated at his place of residence. On 12.04.2021 the patient in our clinic was diagnosed with corneal degeneration and high risk factors for graft rejection in the postoperative period: keratouveitis, secondary ophthalmohypertension, limbal neovascularisation, deep corneal opacity. The patient is admitted to the hospital and preoperative preparation: antibiotics, anti-inflammatories, corticosteroids, midriatics, keratoprotectors. From 13.04.2021 to 19.04.2021 3 sessions of plasmapheresis are carried out. The inflammatory process is solved, the patient underwent a penetrating keratoplasty with femtolaser-assisted OD on April 15, 2021. At discharge on 26.04.2021 local OD status: cornea under MCL, almost completely epithelialized, descemetal membrane folds, sutures adapted. Anterior chamber 2 mm deep, moisture clear. The iris is subatrophic, the pigmentary border is partially leached. Cornea - clouding in the nucleus. Pale pink, clear borders under flare. In 1 month, on 13.05.2021 local status OD: conjunctiva pale pink, no discharge, cornea under ICD, complete epithelialization, nodular sutures 16 units, satisfactory, endothelial tuberosity. Anterior chamber 2 mm deep, moisture clear. Subatrophic iris, pigmentary fringe partially leached, lens - clouding in the nucleus. Advised to continue early treatment. In 3 months, 22.07.2021 local status OD: conjunctiva pale pink, no discharge, graft is almost transparent, epithelium is rough, staining at 2-3 o'clock in paraoptics, nodal sutures 16 units, good, endothelium b/o. Anterior chamber 2 mm deep, moisture clear. Subatrophic iris, pigmentary fringe partially leached, lens - clouding in the nucleus. Pale pink, clear margins under the flare.
Plasmapheresis has proven to be an effective method of combating complications at any stage of the management of a patient requiring corneal transplantation. As a result of the planned surgical procedure, the patient was able to regain corneal transparency. The post-operative DOC was 0.1 (20/200 or 6/60), giving the prospect of higher vision in the future. The patient was satisfied with the result.

Cornea Day: Section 4: Keratoplasty (ESCRS)
18.02.2022 15:30
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2

CR35
CLINICAL CASE OF TREATMENT OF CONGENITAL SEVERE COMBINED PATHOLOGY OF KERATOGLOBUS IN COMBINATION WITH MEGALOCORNEA ON THE BACKGROUND OF UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA.
Artem Zakharovich Ciganov
Keratoconus management
Artem
Zakharovich
Ciganov
Russian Federation
To evaluate the effectiveness of treatment of a patient with keratoglobus against the background of megalocornea and to describe a clinical case of staged corneal keratoplasty in a patient with a very rare combined pathology: Megalocornea and Keratoglobus.
S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.
A 36-year-old woman with a history of undifferentiated connective tissue dysplasia went to the clinic with complaints of low visual acuity in the right eye, the impossibility of selecting a spectacle correction. Diagnosed : megalocornea, advanced keratoglobus in both eyes. With best-corrected visual acuity of 0,05 in the right eye and 0,6 in the left eye. The corneal diameter is 14.2 mm. Keratometry 37.75 D – 84°, 42.25 D – 174°. The minimum thickness of the cornea along the periphery is 109 µm. Complicated cataract. Due to the risk of perforation and low visual acuity, surgical treatment was decided. Initially, penetrating keratoplasty of the right eye was performed in February 2019. A 9 mm trepanation hole was made. Further, after assessing the condition of the residual cornea (sharp thinning along the periphery) , it was excised from limb to limb. Due to the abnormally large capsular bag structure, we had to suture the IOL to the iris after implantation, then the entire corneal-scleral complex was transplanted. Although the likelihood of developing secondary glaucoma was high, the early and late postoperative periods were proceeded without incident. 6 months after surgery, vision = 0.2. However, 18 months after surgery, the patient developed graft disease. Based on objective research data, DSAEK was recommended. In June 2021, the operation was performed. Its course coincided with the traditional one. Although it was complicated by the presence of anomalies in the structure of the eyeball and the patient's somatic condition (the absence of one kidney and other undifferentiated connective tissue diseases). Complete adhesion of the graft was achieved immediately after the operation. Visual acuity after 2 months = 0.3.
Keratoplasty on the eyes with such a sharp combined pathology as megalocornea and keratoglobus always has high risks and unpredictable results. The technique of performing the operation differs from the standard one due to anomalies in the structure of the eyeball. However, this method of performing staged keratoplasty is the only possible way to reduce injuries and increase visual acuity in this situation. The patient has a similar picture in the paired eye. Surgical intervention is planned in the future.
Cornea Day: Section 4: Keratoplasty (ESCRS)
18.02.2022 15:30
18.02.2022 16:40
3

CR36
AN UNUSUAL OCCURRENCE OF EPITHELIAL INGROWTH IMITATING INFECTION FOLLOWING DMEK SURGERY
Isabeau Houben
Infectious keratitis
Isabeau

Houben
Belgium
To report our experience of epithelial ingrowth in the interface post-Descemet membrane endothelial keratoplasty (DMEK) surgery.
Patient was examined, diagnosed and treated by the corneal team in the Ophthalmology Department at University Hospitals of Leicester NHS Trust, a tertiary care hospital.
An 81 year old female with Fuchs' endothelial dystrophy, moderate nuclear sclerotic cataract and mild dry age-related degeneration underwent uncomplicated left DMEK combined with phacoemulsification and intra-ocular lens implant under local anaesthesia. Pre-operative best corrected visual acuity was 0.42 and 0.5 LogMAR in her right and left eye respectively.
Two hours post-surgery air was released from the anterior chamber to reduce intra-ocular pressure from 58 mmHg to 14 mmHg. A 75% air fill was maintained in the anterior chamber.
She was started on guttae Dexamethasone 0.1% two-hourly, guttae Levofloxacin 0.5% two-hourly and guttae Cylopentolate 1% three times of day. On 1 week post-operative review the graft was attached and this was confirmed with anterior segment OCT. There was some corneal oedema in the first month which gradually resolved.
At 7 weeks post-operatively her left visual acuity improved to 0.52 and 0.50 LogMAR, respectively, unaided and with pinhole. However, multiple left inferior corneal graft interface opacities were noted and suspected to be an infectious keratitis.
An emergency left anterior chamber tap was performed for routine cultures and PCR and intra-cameral Voriconazole 0.1 mL (50 mcg/0.1 mL) and Cefuroxime 0.1 mL (1mg/0.1mL) were injected under topical anaesthesia. The patient was started on guttae Levofloxacin 0.5% hourly and guttae Voriconazole 1% hourly. Guttae Dexamethasone 0.1% were temporarily stopped.
Anterior segment optical coherence tomography (OCT) confirmed inferior hyperreflective interface depositions. Bacterial and fungal culture and polymerase chain reaction results from the aqueous tap were negative. Topical antifungal and antibiotic treatment were tapered and discontinued, and topical steroids were recommenced. The opacities appeared to be unchanged clinically and on anterior segment OCT imaging. Confirmation of diagnosis of epithelial ingrowth was later obtained with confocal microscopy.
At 8 months post-operatively, her left visual acuity has remained good at 0.36 and 0.20 LogMAR unaided and with pinhole, respectively.
Epithelial ingrowth can occur after DMEK surgery as it is well described after Descemet stripping automated endothelial keratoplasty surgery. It has a clinical appearance which can mimic insidious infection and with suspicious graft interface opacites appropriate investigation and treatment are required.
Cornea Day: Section 4: Keratoplasty (ESCRS)
18.02.2022 15:30
18.02.2022 16:40
4

CR37
LONGTERM FOLLOW UP OF AN ARTIFICIAL ENDOTHELIAL LAYER FOR TREATMENT OF CHRONIC CORNEAL EDEMA
Gerd Uwe Auffarth
Cornea
Gerd
Uwe
AUFFARTH
Germany
Despite the established efficacy of the Descemet Membrane Endothelial (DMEK) procedure, the challenging preparation methods, shortage of corneal donor, limited access to eye banks and the legal and ethical barriers still restrain access to transplantation. Such issues highlight a need for alternatives such as an artificial endothelial layer
International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Heidelberg University Hospital, Germany
The artificial endothelial layer, the EndoArt® (EyeYon Medical, Ness Ziona, Israel), functions as a hydrophilic water-impermeable plate that is designed to be attached to the recipient's posterior stroma, preventing the inflow of aqueous humor into the stroma and decreasing corneal edema. We present two-year results of the surgical technique for implantation of the artificial endothelial layer in our first two patients with endothelial decompensation that may serve as an alternative to the conventional DMEK and reduce the indication for corneal transplantation. In our two first cases, the artificial endothelial layer led to rapid reduction of the central corneal thickness that persevered until the two-year follow-up examination without any complications. Though the visual acuity did not experience a significant increase, both patients reported high satisfaction and an overall brighter visual quality on the operated eye.
In conclusion, this technique shows feasibility of a novel artificial endothelial layer for treatment of patients with endothelial dysfunction. Further studies with a larger sample size and a longer follow-up period are necessary to establish its long-term efficacy and safety profile
Cornea Day: Section 4: Keratoplasty (ESCRS)
18.02.2022 15:30
18.02.2022 16:40
5

CR38
ENDOTHELIAL KERATOPLASTY IN PATIENT AFTER TASS SYNDROME
Anastasia Khaletskaya
Ocular surface disease: what worked and what did not
Anastasia

Khaletskaya
Russian Federation
To present the technique and unusual intraoperative findings in patient having DSAEK for pseudophakic bullous keratopathy associated with ASS syndrome.
S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
A 66-year-old man was referred to our clinic with complaints on low vision, tearing, photophobia of the left eye (LE). Several years earlier patient had undergone antiglaucoma surgeries elsewhere. IOP was stable. Phacoemulsification (PE) with posterior chamber multifocal IOL implantation was performed on the LE in the other clinic couple of months prior to consultation. On the next day after PE no visual recovery was achieved and the patient was diagnosed with TASS-syndrome. Management was including intensive instillations and injections of steroids.
At the time of examination: LE - flat filtering bleb positioned at 12 o'clock, diffuse limbus-to-limbus corneal edema with Descemet's membrane folds. The anterior chamber was deep with peripheral irido-corneal adhesions, areas of local iris atrophy were noted. Ex-press shunt was visualized at the 2 o'clock position. IOL was in the capsular bag. Fundus examination was not possible. BCVA of LE - 0.1 (decimal), IOP - 15 mmHg. Diagnosis: LE Pseudophakic bullous keratopathy. Primary open-angle glaucoma II A. The decision was made to perform endothelial keratoplasty (DSAEK). During surgery transparent retro-corneal membrane fully covering the iris and extending to the anterior chamber angle was identified. Tube portion of the Ex-press shunt was embedded in the membrane and partially blocked with the iris. Membrane removal with anterior chamber angle cleaning were performed followed by descemetorhexis, insertion of endothelial graft and suturing the surgical wounds. Postoperative period was unremarkable with VA increased up to 0.6 (decimal) 3 mo. after surgery with IOP - 14 mmHg.
TASS syndrome is one of the very serious and deleterious cataract surgery complications. Performing endothelial keratoplasty 3 months after the onset of that condition allowed for relatively quick visual rehabilitation.
Cornea Day: Section 4: Keratoplasty (ESCRS)
18.02.2022 15:30
18.02.2022 16:40
6

CR39
CORNEAL STROMAL LENTICULES FROM RELEX SMILE FOR THE TREATMENT OF CORNEAL ULCERS: CASE REPORTS.
Pavel Studený
Ocular surface disease: what worked and what did not
Pavel

Studený
Czech Republic
Corneal stromal lenticules from ReLEx SMILE for the treatment of corneal ulcers after pterygium surgery: Case report.
Department of Ophthalmology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
The treatment of corneal ulcers is often challenging. In case of keratolysis it may progress to corneal perforation, a condition that must be urgently solved by covering the defect to restore the integrity of the globe and reduce the risk of infection of intraocular tissues. Amniotic membrane transplantation, tissue glue, conjunctiva, or 'patch' made up from donor´s cornea is currently used to temporarily cover the corneal defect. For large defects, it is necessary to perform an acute keratoplasty.
ReLExSMILE is a refractive surgery method, in which a lenticula of corneal stromal tissue is cut within the cornea by femtosecond laser and then mechanically released and removed. It is basically a waste product of the operation. We believe that it should be possible to use such lenticules in patients with deep corneal defects to fill the defect and thereby to postpone or eventually avoid penetrating keratoplasty
We present treatment of corneal ulcer as a result of iatrogenous corneal damage during recurrent pterygia surgery. We successfully closed the defect using a lenticula adn amniotic membrane. Other indications for which it is possible to use this technique and delay or replace perforating keratoplasty will also be presented.

The use of corneal stromal lenticules from ReLEx SMILE may be considered as alternative method for the treatment of corneal ulcers. It seems to be safe and effective to cover temporarily the corneal defect. It´s a suitable method prior to a planned perforating keratoplasty, if necessary.
Cornea Day: Section 4: Keratoplasty (ESCRS)
18.02.2022 15:30
18.02.2022 16:40
7

Sheet 3: Free Papers

FP01
BILATERAL SPONTANEOUS ANTERIOR LENS DISLOCATION AS THE INITIAL PRESENTATION OF HOMOCYSTINURIA
Rahma Saidane
Cataract
Rahma

Saidane
Tunisia
To report a case of bilateral spontaneous anterior dislocation of the crystalline lens as the initial presentation of homocystinuria in a young male patient.
B Department, Hedi Rais Institute of Ophthalmology, Tunis, Tunisia.
Case report
A 32-year-old male presented to our department with acute ocular pain in his left eye (LE) and severe headache. There was no history of trauma. Visual acuity (VA) was limited to counting fingers. Slit-lamp examination revealed mild conjunctival hyperemia and diffuse corneal stromal edema. The LE lens dislocated into the anterior chamber (AC),and the right one had stretched zonular fibers with inferior subluxation. Intraocular pressures (IOP) were 67mmHg and 15mmHg in the LE and right eye(RE), respectively. Fundus examination was unremarkable in the RE. The initial management included anti-glaucoma (dorzolamide, timolol, brimonidine) and dexamethasone eye drops. He was positioned supine and given analgesia and intravenous mannitol 1g/kg. Subsequently, his LE IOP dropped to 24 mmHg. The following morning, the patient underwent urgent lens extraction with anterior vitrectomy under general anesthesia and was left aphakic. At one-week follow-up, the patient reported an improvement of blurred vision and pain in the LE. The VA was 6/60 in the LE. The IOP was 14mmHg. Slit lamp examination demonstrated mild conjunctival hyperemia and clear cornea. Fundus examination of the same eye revealed superior temporal branch retinal vein occlusion. The patient agreed to elective RE lens extraction and implantation of an intraocular lens. Secondly, we scheduled iris-claw implantation in his LE. Two weeks later, the patient re-attended the emergency department, this time for severe pain in his RE. The lens has displaced into the AC. The IOP was 60mmHg. He again was admitted to the ophthalmic ward. The patient was treated with the same pharmacological regime as described previously. His IOP decreased to 20mmHg. The following day he underwent a lens extraction, anterior vitrectomy without implantation. These findings were consistent with the diagnosis of bilateral ectopia lentis, secondary to classical homocystinuria. The patient was reffered to internal medicine department for further investigations. His serum homocysteine levels were 200 mmol/l (reference range< 10 mmol/l). He was started on pyridoxine and advised intake of methionine restricted diet. A week later, he presented left lower extremity deep venous thrombosis.
In the absence of trauma, ectopia lentis should elicit a search for an underlying hereditary or systemic cause. In these cases, homocystinuria must be considered. Lens subluxation is usually posterior, bilateral, and inferonasal. Bilateral anterior dislocation is rare. Homocystinuria management requires collaboration between ophthalmologists and internists to prevent serious general and ocular complications.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
1

FP02
SCLERAL FIXATION OF SINGLE-PIECE FOLDABLE IOL USING DOUBLE-FLANGED PROLENE SUTURE...A NEW TECHNIQUE
Ahmed Samir
Cataract
Ahmed

Samir
Saudi Arabia
To describe the efficiency and visual results of a new method of transconjunctival intrascleral fixation of single-piece foldable IOL using double-flanged 6/0 prolene suture
magrabi eye hospital
jeddah
ksa
twelve aphakic eyes of 12 patients without adequate capsular support were involved in this study. Lens was prepared by passing the 6/0 prolene suture in a track in the haptic of single-piece foldable IOL created by 31 g needle. The 6/0 prolene suture was retrieved through a 30 g needle transconjunctivally to outside the globe; then, IOL was implanted and a terminal bulb was created at the outer end of the prolene suture.
All cases were aphakic after complicated phacoemulsification. In 8 cases hydrophilic IOLs were used and in 4 cases hydrophobic IOLs were used. There is clear statistically significant difference between pre-UCVA and post- UCVA.
Transconjunctival intrascleral fixation of foldable single-piece IOLs is a safe efficient method for correcting aphakia.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
2

FP03
COMPLICATIONS OF CATARACT SURGERY: UVEITIS-GLAUCOMA-HYPHEMA SYNDROME
Laura Armonaite
Cataract
Laura

Armonaite
Sweden
To assess underlying risk factors, clinical picture and IOL-iris contact signs in Uveitis-Glaucoma-Hyphema syndrome (UGH).
St. Erik Eye Hospital, Stockholm, Sweden.
In a retrospective case-control study with a cross-sectional component, 3 groups with 71 patient each were compared: UGH syndrome, dislocated IOL without UGH and ordinary pseudophakia. Main outcome measures were IOL-iris contact signs (iris defects, pseudophacodonesis, IOL dislocation and malposition) and use of blood thinners.
Blood thinners were not more frequent in the UGH group (P=0.1). Iris defects were not more frequent in the UGH than in the Dislocated group but their form differed significantly (P<0.0001). Pseudophacodonesis (22.5 %) occurred more frequently in UGH than in ordinary pseudophakia (P=0.001). IOL with one haptic or entire 1-piece IOL in ciliary sulcus was observed only in the UGH group (30 %). UGH manifested as intraocular hemorrhage in 91 % of patients, while 8 % had iritis, pigment dispersion or macular edema. UGH syndrome mimicked other diagnoses in 13% of cases.
Pseudophacodonesis and 1-piece IOL implantation in the ciliary sulcus are risk factors for UGH, meanwhile blood thinners are not. Iris defects are not specific to UGH unless they are formed like the IOL haptic or optic edge. UGH syndrome has a large clinical variety.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
4

FP04
S.P.E.C.I.A.L (SITTING PHACOEMULSIFICATION OF CATARACT AND INTRAOCULAR LENS IMPLANTATION)
JEBINTH BRAYAN
Cataract
Jebinth

BRAYAN
India
1.To assess the outcome of phacoemulsification with Intra Ocular Lens Implantation in Sitting position
2.To determine the efficacy of phacoemulsification in sitting position
3.To assess the challenges faced by the surgeon in face to face sitting phacoemulsification and how to overcome them
Hospital based prospective study, done at a secondary eye care centre, study duration 3 months, sample size 25 patients, inclusion criteria - patients unable to lie flat - Spine deformity, Kyphosis, Scoliosis, Orthopnea, Meniere disease etc. detailed history, general, systemic and ocular examination done and documented
Patient was made to sit in a plastic chair erect at 90 degree face to face with the surgeon - who carried out phacoemulsification & foldable intraocular lens implantation in 27 such cases. the microscope was adjusted to make it compatible for sitting phacoemulsification. data on visual acuity, biometry, complication, vitals was then entered and analysed using SPSS software.
demographic data : male (15)> female(12); male age group with highest cataract was in the range of 60-69(8 cases) and females 50-59(10cases); pre operative, intraoperative and postoperative statistics of blood pressure,pulse,spo2 were recorded which shows no statistically significant changes which means the patients had stable vitals during the surgery. BCVA-significant improvement in PostOperativeDay -1,30,60,90 days,88% patient with 6/6. On average LE surgery took 9.8mins,C.D.E energy of 9.6 & RE took 11.4mins & 17.4 C.D.E respectively. Surgery time in Mature Cataract(MC)> Immature Cataract(IMC) by 3 mins & twice the phaco energy for MC than IMC
S.P.E.C.I.A.L has given an insight on the statistical data on phacoemulsification carried out in sitting position. It might be the only option for some patients & this is the only study with 90degree surgery being conducted on patients who cannot lie down supine for cataract surgery.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
5

FP05
RISK FACTORS AND IMPACT OF INTRAOCULAR LENS CHARACTERISTICS ON INTRAOCULAR LENS DISLOCATION AFTER CATARACT SURGERY – A POPULATION STUDY
Maximilian Gabriel
Cataract
Maximilian

GABRIEL
Austria
To assess and identify risk factors including intraocular lens (IOL) characteristics on IOL dislocations after cataract surgery.
Retrospective cohort study.
Cox proportional-hazard regression models were used to assess the influence of risk factors including IOL characteristics on IOL dislocations. Patients that underwent cataract surgery at the Medical University Graz (Austria) between 1996 and 2017 were included.
68 199 eyes of 46 632 patients (60.2% women, mean age: 73.71 SD±10.82 years) underwent uncomplicated phacoemulsification during the study period. 111 patients (0.16%) had in-the-bag (ITB) and 35 (0.05%) out-of-the-bag (OTB) dislocations. The adjusted hazard ratio (HR) associated with a higher risk for ITB dislocations was 5.09 (95% CI, 2.76 - 9.38) for weak zonula fibers, 14.36 (95% CI, 9.24 - 22.32) for pseudoexfoliation, 2.08 (95% CI, 1.38 – 3.14) for uveitis and 1.97 (95% CI, 1.38 – 2.83) for retinitis pigmentosa. Higher age (HR 0.97, 95% CI, 0.95 - 0.98) was associated with a lower risk. Hydrophilic IOLs (HR 2.35; 95% CI, 1.45 - 3.80), quadripode IOLs (HR 2.01; 95% CI, 1.04 – 3.86), and haptic angulation (HR 1.61, 95%, 1.04 - 2.48) were associated with a higher risk. A lower risk was observed for three-piece-IOLs (HR 0.58, 95% CI, 0.34 - 0.98) and larger overall IOL diameter (HR 0.79, 95% CI, 0.66 - 0.95). For OTB dislocations, the HR associated with a higher risk was 18.81 (95% CI, 5.84 - 60.58) for silicone IOLs, 2.12 (95% CI, 0.62 - 7.29) for hydrophilic and 3.39 (95% CI, 1.69 - 7.15) for male gender. Higher age (HR 0.97, 95% CI, 0.95 - 0.99) and larger overall IOL diameter (HR 0.40, 95% CI; 0.25 - 0.63) showed a lower risk.
This study provides a hierarchy of risk factors for ITB dislocations: Pseudoexfoliation, weak zonular fibers, hydrophilic IOLs, quadripode IOLs, and haptic angulation. Three-piece IOLs and a larger overall diameter were associated with a lower risk. Risk factors for OTB dislocations were silicone IOLs, hydrophilic IOLs, male gender, a smaller overall IOL diameter and young age.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
6

FP06
FACTORS PREDISPOSING TO INTRAOPERATIVE FLOPPY IRIS SYNDROME (IFIS): AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS
Argyrios Tzamalis
Cataract
Argyrios

Tzamalis
Greece
Initially, IFIS was correlated with the intake of tamsulosin, a selective a1- adrenergic receptor antagonist (a1-ARA). However, since then, multiple studies have investigated a plethora of risk factors that could potentially predispose to IFIS. Our primary aim is to provide an updated meta-analysis regarding all the identified predisposing to IFIS factors. A secondary objective is to evaluate the reported prophylactic measures in addressing IFIS.

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece

The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search for potentially eligible articles was conducted via the MEDLINE and Cochrane Library bibliographical databases. Meta-analysis was carried out to estimate the association of each variable with the occurrence of IFIS. Based on the extracted data, odds ratios (ORs) and 95% confidence intervals (CIs) were either calculated by constructing 2x2 tables for each categorical outcome or extracted from univariable logistic regression analyses reported in the original publications. The random-effects model (DerSimonian-Laird) was adopted to calculate the pooled effect estimates for all variables of interest due to the significant clinical heterogeneity among the included studies.

39 studies were finally included in the analysis. The factors that were found to predispose to IFIS significantly were the male gender (OR: 4.25/CI:2.58-7.01), hypertension (OR: 1.55/CI:1.01-2.37), tamsulosin intake (OR:31.06, CI: 13.74-70.22), finasteride intake (OR: 4.60/ CI: 1.97-10.73), benzodiazepines intake (OR: 2.88, CI:1.17-7.12) and antipsychotics intake (OR:6.91, CI: 2.22-21.50). A decreased dilated pupil preoperatively was found predisposing to IFIS (weighted mean difference: -0.93, CI: -1.19, -0.67). Investigated factors that were studied as potential predisposing factors to IFIS occurrence that did not reach statistical significance were age, diabetes melitius, axial length, glaucoma, pseudoexfoliation, the duration of tamsulosin intake, alfuzosin intake, doxazosin intake, prazosin intake, and terazosin intake. Finally, intracameral epinephrine which was investigated as a potential prophylactic measure for preventing IFIS, did not reach statistical significance (OR: 0.29, CI: 0.08-1.06).

To date, the major factor that predisposes to IFIS is tamsulosin. A comprehensive preoperative assessment of all the factors predisposing to IFIS is vital to stratify the surgical risk, which is crucial in addressing IFIS since unanticipated IFIS could turn a routine surgery into one of significant visual morbidity. Further comparative studies are required to investigate how various prophylactic measures prevent the occurrence of IFIS.

Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
7

FP07
WHEN SHOULD CATARACT SURGEONS SEEK ASSISTANCE FROM EXPERIENCED COLLEAGUES
Eirini Oustoglou
Cataract
Eirini

Oustoglou
Greece
To assess which cases should be assorted exclusively to high-volume surgeons and identify when should a cataract surgeon seek assistance from a senior colleague.
A retrospective cohort study in a single tertiary hospital.
Medical records of 2853 patients with age-related cataracts were reviewed. Preoperative risk factors were documented for each case, and they were all divided into surgeons with more (>400 surgeries per year) or less experience (<400 surgeries per year). Trainees were excluded. Complicated cases were defined as posterior capsule rupture, dropped nucleus, zonular dehiscence and anterior capsular tear with or without vitreous loss.
From the 3247 eyes included, the two groups did not have any statistically significant difference in the complication rates. In the stepwise regression analysis, both groups supported advanced age (>85) and mature cataracts with almost fourfold odds ratios (OR), except for high volume surgeons and advanced age where the OR were 2.6 towards complication. Low volume surgeons had a fivefold OR in the presence of phacodonesis and fourfold in the case of posterior polar cataract. Finally, the low and high-volume groups had their highest complication rates in the cumulative four and five risk factors, respectively.
In the presence of certain risk factors such as advanced age (>85), mature cataracts, phacodonesis and posterior polar cataracts, the complication rates appear to increase in less experienced surgeons. The meticulous registration of risk factors in the preoperative assessment can prevent complications through assistance or assignment to a more experienced surgeon.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
8

FP08
TECHNIQUE OF PPCCC (PRIMARY POSTERIOR CONTINUOUS CURVILINEAR CAPSULORHEXIS) WITHOUT VISCOMATERIAL
Pavel Studený
Cataract
Pavel

Studený
Czech Republic
Primary posterior continuous curvilinear capsulorhexis (PPCCC) is still a relatively controversial technique used for secondary cataract prevention. However, it has justifications in some specific indications (surgery of children, handicapped patients). Due to the many advantages that this technique offers, this procedure is currently used by some surgeons also in standard cataract surgeries in adult patients. Usually, a technique using a viscomaterial is used, which reduces the risk of vitreous prolapse during the surgery. The authors present a method of performing PPCCC under an implanted intraocular lens without the use of a viscomaterial and observe the occurrence of perioperative complications in connection with this technique.
Ophthalmology Department, 3rd Medical Faculty, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
PPCCC was performed on a total of 200 consecutive adult patients with cataract surgery, without the use of a viscomaterial. All possible surgical complications related to this technique were documented.
In the monitored group, no vitreous prolapse into the anterior chamber occurred, in one case (0.5%) a damage of the anterior vitreous membrane was discovered, in five cases (2.5%) PPCCC was teared into the periphery and in five cases (2.5%) %) the PPCCC formed was larger than the optical part of the intraocular lens (6mm).
The PPCCC technique without the use of viscomaterial was not, for our monitored group, the cause for greater number of more serious perioperative complications and thus appears to be a safe technique used for opening the posterior capsule during cataract surgery and for secondary cataract prevention.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
9

FP09
POSTERIOR CONTINUOUS CURVILINEAR CAPSULORHEXIS WITH ANTERIOR VITRECTOMY VERSUS OPTIC CAPTURE BUTTONHOLING WITHOUT ANTERIOR VITRECTOMY IN PEDIATRIC CATARACT SURGERY
Thomas Kohnen
Cataract
Thomas

KOHNEN
Germany
To investigate long-term complications following pediatric cataract surgery with implantation of a heparin-coated PMMA IOL and posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy versus PCCC without anterior vitrectomy with optic capture buttonholing.
Department of Ophthalmology, Goethe University, Frankfurt, Germany
Eyes with unilateral or bilateral congenital cataract without further pathologies or former surgeries were randomly assigned in two groups: cataract removal, IOL implantation and PCCC with anterior vitrectomy (AV; group A) or posterior optic buttonholing without anterior vitrectomy (optic capture, OC; group B). The main outcome measures were posterior capsule opacification (PCO), complication rates and refractive development.
58 eyes of 41 pediatric cataract surgery patients were included. The mean age at time of operation was 66.05 months (± 29.39). In group A (n=26), two eyes required treatment for posterior capsule opacification, whereas the optic axis remained clear in all eyes in group B (n=30), which was not statistically significant. Additionally, group B had a slightly lower rate of complications. Mean SE after a mean postoperative follow-up of 6.5 years was -0.11 ± 2.51 D (-5.0 to +4.0 D) in group A and -0.08 ± 2.14 D (-5.0 to +4.0 D) in group B, which was not statistically significant either.
Optic capture proved to be a safe technique in the prevention of secondary cataract formation without a higher rate of complications and the necessity of vitrectomy, even in an rigid heparin-coated PMMA IOL.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
10

FP10
VISUAL PERFORMANCE AND STABILITY OF A NOVEL CAPSULORRHEXIS-FIXATED INTRAOCULAR LENS
Jorge Sánchez Molina
Cataract
Jorge

Sánchez Molina
Spain
To evaluate the refractive results and positional stability of a new model of capsulorrhexis-fixated intraocular lens (IOL).
Ophthalmology Department, Hospital Universitario Donostia
This prospective study evaluates 20 eyes of 10 patients who underwent implantation of an extended depth of focus (EDOF) capsulorrhexis-fixated IOL (FEMTIS FB-313 MF15) following femtosecond laser assisted cataract surgery. Visits were performed on day 1, 30 and 180 after surgery. The mean outcomes measures were non corrected distance, intermediate and near visual acuities (UDVA, UIVA and UNVA respectively), corrected distance, intermediate and near visual acuities (CDVA, CIVA, CNVA respectively), spherical equivalent and the position of the IOL in relation to the capsulorrhexis. Quality of vision was assessed using the VFQ-25 questionnaire.
180 days after surgery, binocular UDVA, UIVA and UNVA were 0,00 ± 0,00 (SD), 0,14 ± 0,13 and 0,27 ± 0,22 logMAR respectively. No statistically significant differences were found in UDVA and CDVA between 30 and 180 days after surgery. Mean spherical equivalent (SE) at the last visit was 0,19 ± 0,5 diopters (D). 72,22% of the eyes had an SE between -0,5 and +0,5 D and 100% between -1,0 D and 1,0 D. All the implanted IOLs remained correctly centered and positioned at the level of the anterior capsule at all visits. Distance between the posterior iris surface and the IOL was 317,12 ± 73,20 microns, there was no correlation for this distance and visual acuity. Posterior capsular opacification was not observed. VFQ-25 questionnaire revealed a mean score of 92,57 ± 7,02.
This novel capsulorrhexis-fixated EDOF IOL (FEMTIS FB-313 MF15) achieved satisfactory visual and refractive outcomes while offering a good positional stability. In addition, this model could be an excellent design to develop future IOLs.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
11

FP11
EFFECTIVE LENS POSITION AND REFRACTIVE OUTCOME OF A NOVEL RHEXIS-FIXATED IOL
Detlef Holland
Cataract
Detlef

HOLLAND
Germany
WE sought to evaluate differences in effec- tive lens position (ELP) based on the lens design. Intraoc- ular lenses (IOLs) with plate-haptic, c-loop haptic, and a rhexis-fixated lens were compared.

Retrospective, multicenter, comparative case series.

The study included patients having age- related cataract surgery with implantation of either a plate-haptic, c-loop haptic, or a novel rhexis-fixated IOL. Biometry and refraction measurements were con- ducted preoperatively and 3 months postoperatively. Lens constant optimization was performed.
Seventy eyes of 56 subjects were included. ELP for rhexis-fixated IOL was shortest (4.29 ± 0.24 mm), followed by c-loop haptic (4.41 ± 0.42 mm) and plate-haptic (4.51 ± 0.26 mm) IOL. Difference in ELP was significant between rhexis-fixated IOL and both plate-haptic (P [ .001) and c-loop haptic IOL (P [ .000). Anterior chamber depth adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P< .05). For the rhexis-fixated IOL the differences in refraction ranged from L0.039 diopters (D) for the Hill-Radial Basis Function to L0.096 D for Haigis. The other 2 lenses showed mean differences in refraction between D0.046 D for Hill-Radial Basis Function and D0.097 D for Haigis.

The difference in IOL fixation and its resulting position in the capsular bag have a significant ef- fect on the effective lens position and consequently a sig- nificant effect on the prediction of postoperative refraction.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
12

FP12
PILOT INVESTIGATION INTO DEVICE DEFICIENCIES AND CORNEAL MORPHOLOGY WITH FOUR IOL DELIVERY SYSTEMS.
Mayank A Nanavaty
Cataract
Mayank

Nanavaty
United Kingdom
A pilot study to evaluate the performance of an automated preloaded intraocular lens (IOL) system (AutonoMe (A)), two non-automated preloaded (iTec (iT) and iSert (iS)) and a manual delivery system (Monarch III (MIII)) in terms of injector deficiencies, corneal morphology and clinical outcomes, at 2.5 hours and 1 month post cataract surgery.
University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom & Univesity Clinic Frank Furt, Germany.
Prospective, multicenter, randomized, observer-masked pilot study of 24 subjects (N=48 eyes, 12/group). The 4 injectors were evaluated for deficiencies such as haptic trailing, nozzle tip splitting, IOL damage and sudden IOL injection. Anterior segment ocular coherence tomography (AS-OCT) was performed to evaluate corneal incision size, epithelial and endothelial gaping and misalignment, central corneal thickness (CTT), and corneal thickness at the incision site (CTIS). Specular microscopy was performed to assess endothelial cell counts (ECC). Clinical outcomes of best-corrected distance visual acuity (BCDVA) and surgically induced astigmatism (SIA) were also captured.
Injectors A and MIII displayed 0 device deficiencies. iT and iS had 11 and 9 deficiencies respectively, the most common of which were nozzle tip splitting and sudden IOL ejection. At 2.5 hours, incision gaping was highest in iS (50.0%) due to epithelial gaping (iT: 16.7%, MIII: 8.3% and A: 8.3%). No epithelial misalignment was found in A or MIII versus 3 eyes with iS and iT each. At 1 month all but 1 eye (iT) were fully healed. CTT and CTIS were similar among injectors, and numerically greater in the A group. At 1 month, mean BCDVA ranged from -0.008 logMAR with Clareon IOLs (A) to 0.055 Tecnis ZCB00 (iT). ECC was similar between the systems. SIA magnitude was lowest with A and MIII.
This pilot study found that A and MIII have lower device deficiencies than iT and iS. Initial epithelial gaping and misalignment settles at 1 month. The AS-OCT is not the best tool to evaluate incision size and location at 2.5 hours post-operatively.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
13

FP13
LONG-TERM OUTCOMES OF SULCUS IMPLANTATION OF HYDROPHILIC SINGLE-PIECE ACRYLIC INTRAOCULAR LENS
Khaled Elubous
Cataract
Khaled

Elubous
Jordan
There are limited data on the outcomes of sulcus implantation of hydrophilic single-piece acrylic intraocular lens (IOL), with wide controversies in their conclusions. This study aims to evaluate the long-term outcomes of the sulcus implantation of these types of IOLs.
All the eyes were operated on at a single institution (Jordan University Hospital, Amman, Jordan) between January 2015 and June 2020.
This is a retrospective medical chart review. In this study, we included eyes that underwent sulcus implantation of hydrophilic single-piece acrylic IOL. Phacoemulsification and anterior-vitrectomy were performed in all cases. Two types of IOL had used, namely the RayOne Aspheric (RAO600C) and the Medicontur (Bi-Flex HL 677AB). Patients having a follow-up duration of fewer than six months have been excluded. We also excluded patients having a history of uveitis, glaucoma, or ocular trauma. The outcome measures were adverse events, IOL stability, intraocular pressure (IOP), corrected distance visual acuity (CDVA), and the risk of a second surgery.
Twenty-four eyes (24 patients) were included. The mean follow-up duration was 19.7 months ± 12.8 (SD). There was a statistically significant improvement in CDVA (p-value = .0005), with 75% of eyes achieving visual acuity ≥ 20/40. Excluding two eyes with preoperative chronic maculopathy, 81.8% achieved CDVA above or equal to 20/40. There was no significant difference between preoperative and postoperative IOP (p-value =0.41). Postoperative complications were persistent elevation of IOP in four cases (17%), IOL instability (decentration, tilt, or dislocation) in 4 cases (17%), and 1 case (4%) of retinal detachment. Three patients (13%) required surgical interventions for IOL dislocation, retinal detachment, or uveitis-glaucoma-hyphema syndrome.
The sulcus implantation of hydrophilic single-piece acrylic IOL resulted in favorable long-term visual outcomes. Elevated intraocular pressure due to pigment release was the most worrisome complication, particularly in eyes at risk of glaucoma.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
14

FP14
SUPPLEMENTAL MULTIFOCAL INTRAOCULAR LENSES (SMIOL) FOR PRESBYOPIA MANAGEMENT IN THE CILIARY SULCUS: A SYSTEMATIC REVIEW
Carlos Rocha-De-Lossada
Cataract
Carlos

Rocha-de-Lossada
Spain
To summarized and critical review the scientific peer-reviewed current literature regarding the use of supplemental multifocal intraocular lens (SMIOL) in the ciliary sulcus.
Department of Ophthalmology, Qvision, Vithas AlmerÍa. Spain
This systematic review were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. According to the inclusion and exclusion criteria previously defined, 15 articles were included. All of them was carefully analyzed. Risk of bias was assessed with the Quality Assessment Tool for Case Series Studies from the National Heart, Lung, and Blood Institute.
384 eyes of 227 patients were finally analyzed. Most of the studies had a short follow-up, as well as a poor or limited methodological design. Case reports, case series and clinical trials with various gaps were included. Most of the articles reviewed (13/15) achieved a risk of bias score between 6 and 8, representing a high level of evidence despite study design limitations. Postoperative uncorrected distance and near visual acuity ranged from 20/40 to 20/20 and 0.4 to 0.02 logMAR, respectively. Regarding complications, pigment dispersion (12 eyes) and deposits (13 eyes) were the most described in the literature. Dysphotopsias, in the form of glare and halos, were the most frequent visual disturbances. However, most patients reported a high level of satisfaction with their surgery.
SMIOLs seem to obtain a good far and near visual outcomes. According to this study, this fact leads patients to high levels of spectacle independence and satisfaction. Moreover, limited complications associated with SMIOL were reported in the literature. However, more and better studies are still needed to confirm these results.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
15

FP15
CLINICAL OUTCOMES OF RETROPUPILLARY IRIS SUTURE FIXATED RIGID INTRAOCULAR LENS
Sankar Ananthan
Cataract
Sankar

ANANTHAN
India
To report clinical outcomes of retro-pupillary iris suture fixated rigid intraocular lens (IFIOL) for eyes with compromised capsular bag support and to stabilize decentered IOLs
Tertiary care ophthalmic hospital
This study included all eyes undergoing IFIOL with a minimum follow-up of 6 months between April 2019 and January 2021. Patients with pre-existing anterior or posterior segment pathologies causing defective vision, uveitis or history of previous intraocular surgeries with exception of cataract surgery were excluded from the study. Data were retrieved from electronic medical records and we documented demographics, history, position of cataractous lens or IOL, primary/secondary surgery and its complications. Post-operative visual acuity, pupillary response, diplopia, centeration of IOL and inflammation were recorded at the baseline visit and at 1 month, 3 months and 6 months postoperatively.
One hundred and ten eyes of 110 patients that underwent IFIOL were evaluated. Twenty two patients (20%) underwent primary IFIOL whereas 67 (60.9%) patients had secondary IFIOL. In 18 patients (16.36%), IFIOL was done to reposition decentered/dislocated IOLs. At the final follow-up, there was a significant improvement in corrected distance visual acuity (CDVA) with 87 patients (79.09%) achieving CDVA of 6/12 or better. IFIOL was stable and centered in 101 eyes (91.81%). Two patients (1.81%) had intra-operative complications. Post-operative iritis was seen in 7 patients (6.36%) and 4 patients (3.63%) had IOP rise.
This is a safe, reliable and reproducible technique for aphakia rehabilitation and decentered IOL stabilisation with good clinical outcome, especially in a limited resource setting.
Cataract Surgery Complications & Special Cases & New Diagnostic Modalities
18.02.2022 08:30
18.02.2022 10:00
15

FP16
EVALUATION OF CORNEAL ENDOTHELIUM AFTER MYOPIC LASER-ASSISTED IN SITU KERATOMILEUSIS (LASIK) WITH ACCELERATED CROSS-LINKING (CXL) IN DIABETIC PATIENTS.
Mohamed Mahmoud
Refractive
Mohamed

Mahmoud
Egypt
to study the effect of LASIK with accelerated CXL on corneal endothelium in myopic diabetic patients.
A prospective comparative interventional case series study on 120 eyes of 60 myopic patients treated with LASIK with accelerated CXL. They were divided into two groups, group A included 60 eyes of diabetic patients, group B included 60 eyes of non-diabetic patients. Corneal endothelium was evaluated by specular microscope preoperatively and after 3 and 6 months postoperatively
A prospective comparative interventional case series study on 120 eyes of 60 myopic patients treated with LASIK with accelerated CXL. They were divided into two groups, group A included 60 eyes of diabetic patients, group B included 60 eyes of non-diabetic patients. Corneal endothelium was evaluated by specular microscope preoperatively and after 3 and 6 months postoperatively
The endothelial cells density (ECD) showed statistically significant changes after 3 and 6 months postoperatively (p-value<0.001) in group A while group B showed statistically significant changes after 3 months without significant change after 6 months (p-value= 0.103), both groups had improved to near preoperative levels, with no significant differences between them at the end of 6 months follow-up (p-value = 0.219). Regarding pleomorphism, there was a significant change in group A during 6 months follow-up (p-value<0.001) with no significant change in group B (p-value= 0.884), and in comparing both groups, there was a significant change at the end of 6 months follow-up (p-value<0.001). Regarding polymegathism, there was a significant change in group A during 6 months follow-up (p-value<0.001) with no significant change in group B after 3 (p-value= 0.178) and 6 (p-value= 0.866) months follow-up and in comparing both groups, there was a significant change at the end of 6 months follow-up (p-value<0.001).
LASIK with accelerated CXL is safe on corneal endothelium in diabetic myopic patients but needs to follow up for a long period.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
1

FP17
CHANGES IN CORNEAL BIOMECHANICS AFTER LASER IN SITU KERATOMILEUSIS AND PHOTOREFRACTIVE KERATECTOMY
Catarina Castro
Refractive
Catarina

CASTRO
Portugal
To evaluate the changes in dynamic corneal response second-generation parameters and biomechanically corrected intraocular pressure (bcIOP) after femtosecond laser-assisted laser in situ keratomileusis (FemtoLASIK) and photorefractive keratectomy (PRK).
Refractive Surgery Unit of Ophthalmology Department of Centro Hospitalar Universitário do Porto, Oporto, Portugal
Prospective observational study that included 87 eyes (44 patients) submitted to keratorefractive surgery between November 2020 and April 2021 in Centro Hospitalar Universitário do Porto. FemtoLASIK was performed in 62 eyes and PRK was performed in 25 eyes. The dynamic corneal response second-generation parameters and bcIOP were measured with the OCULUS Corvis® ST, a dynamic Scheimpflyg analyzer. Deformation amplitude ratio 1.0 mm (DA-Ratio), stiffness parameter at first applanation (SP-A1), Ambrósio relational thickness through the horizontal meridian (ARTh), integrated radius (IR), corvis biomechanical index (CBI) and bcIOP were evaluated before the surgical procedure and at 1 and 6 months after surgery.
In the FemtoLASIK group, comparing to the preoperative values, there was an increase in IR and CBI, a decrease in SP-A1, ARTh and bcIOP (p<0.002) and no change in DA-ratio (p>0.183) both at month 1 and month 6. Between month 1 and month 6 there was an increase in ARTh1 and a decrease in bcIOP (p<0.017) and no changes in DA-ratio, SP-A1, CBI and IR (p>0.107). In the PRK group, comparing month 1 to preoperative values, there was an increase in DA-ratio, IR, bcIOP and CBI and a decrease in ARTh (p<0.021) and no change in SP-A1 (p=0.784). At month 6, compared to preoperative values, there was in increase in DA-ratio, IR and CBI and a decrease in SP-A1, ARTh and bcIOP (p<0.002). Between month 1 and month 6 there was an increase in IR and CBI and a decrease in bcIOP and SP-A1 (p<0.031) and no change in ARTh and DA-ratio (p>0.368). The changes in IR, CBI, and ARTh (p<0.001) were more significant in the FemtoLASIK group. Between month 6 and preoperative values, the changes in SP-A1 (p=0.032) were also superior in the FemtoLASIK group, but the changes in bcIOP were similar in both groups (p=0.871). Between month 1 and month 6, the changes in bcIOP were superior in the PRK group (p<0.001).
Both FemtoLASIK and PRK seem to induce corneal biomechanical changes, towards weakening of structures. FemtoLASIK seems to induce greater biomechanical changes than PRK. A longer follow-up would be interesting to evaluate the sustainability of these changes overtime.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
2

FP18
MINIMALLY INVASIVE, RAPID-RECOVERY RAY TRACING CUSTOMIZED MYOPIC PRK: ONE-YEAR CLINICAL DATA OF A NOVEL TECHNIQUE
Anastasios John Kanellopoulos
Refractive
Anastasios
John
Kanellopoulos
Greece
Safety and efficacy customized-minimal PRK
20 patients (40 eyes) underwent customized PRK for myopia with custom-shape and diameter epithelial removal, Bromfenac 0.9mg/ml the first postoperative day. Visual acuity, CDVA, UDVA, refraction, post-operative pain measured on a subjective scale, epithelial healing and epithelial mapping profile were evaluated for 12 months.
20 patients (40 eyes) underwent customized PRK for myopia with custom-shape and diameter epithelial removal, Bromfenac 0.9mg/ml the first postoperative day. Visual acuity, CDVA, UDVA, refraction, post-operative pain measured on a subjective scale, epithelial healing and epithelial mapping profile were evaluated for 12 months.
Pain scores were 0.27 ± 0.15 (0-4). Day 2 epi-defect was 1.52 ± 1.23 mm2. 8 eyes were not epithelialized by day 3, and none by day 4. 4 patient's reported use of additional analgesia. All eyes were 20/25 immediately after the procedure and all 20/25 by day 4. At 3 months UDVA was 20/15,5, Residual refractive error: -0.15 Diopters. Residual manifest cylinder -0.18 Diopters; high order aberrations: 0,21um.
PRK, may minimize pain and visual debilitation, by accelerating re-epithelialization and early visual recovery. These data appear superior to LASIK and Smile for the immediate postop rehabilitation and restrictions, similar in discomfort experienced with both of these lamellar procedures, with a potentially superior intra-operative safety profile.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
3

FP20
EX-VIVO STUDY ON SURFACE QUALITY OF CORNEAL LENTICULE AND STROMA AFTER LOW ENERGY FEMTOSECOND LASER LENTICULE EXTRACTION
Mayank A Nanavaty
Refractive
Mayank

Nanavaty
United Kingdom
To assess the surface quality of cap, stroma and lenticular surfaces created using low energy femtosecond laser lenticule extraction (Ziemer FEMTO LDV Z8)
Laboratory study
Freshly isolated porcine eyes (n=24) were divided into 4 groups (n=6 each): two with optimal laser power settings (32%) with posterior curvature equivalent to a sphere correction of -2D and -5D respectively and other two with high power settings (64%) with sphere correction of -2D and -5D respectively. After suitable dissection by a single surgeon and standard processing, samples were analysed via scanning electronic microscopy (SEM). Surface morphology was evaluated using previously published scoring system; surface relief, surface regularity, extent and position of irregularities were graded by four independent clinicians.
Eyes with optimal laser power settings (32%) and correction of -2D had significantly less size of irregular area as compared to those with -5D correction; however, no significant difference was found between the two groups with higher laser power (64%). When comparing eyes with -2D correction, size of the irregular area was significantly lesser with optimal laser power group. Surface relief was significantly lesser with -5D correction in optimal laser power group as compared to high power laser group.
Low energy femtosecond laser lenticule extraction (Ziemer FEMTO LDV Z8) produces good surface quality results. In general, there is a tendency for smoother surface stromal quality with lower laser power settings as compared to higher power.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
5

FP21
6.-MONTH FOLLOW UP OF NOVEL LENTICULAR PROCEDURE - SMARTSIGHT
Maja Bohač
Refractive
Ivan

gabric
Croatia
To evaluate refractive and visual outcomes over a six-month period of Small Incision Guided Human-cornea Treatment (SmartSight®, SCHWIND eye-tech-solutions, Kleinostheim, Germany) in the treatment of myopic astigmatism with the use of a new femtosecond laser system.
Eye clinic Svjetlost, Zagreb, Croatia
This retrospective, observational case series included 90 eyes of 45 patients who underwent SmartSight to correct myopic astigmatism and completed at least 6-month follow-up. All procedures were performed by the same surgeon using the SCHWIND ATOS® femtosecond laser. All patients were evaluated preoperatively for suitability for laser refractive surgery and followed up for a minimum of 180 days. Analysis of visual and refractive outcomes, as well as Alpins Method for the analysis of Astigmatism has been performed.
This non-randomized prospective cases series enrolled 90 eyes of 45 patients. All patients
underwent uneventful SmartSight lenticule extraction. Preoperatively, mean spherical manifest
refraction(MRSE) was -5.1±1.9 diopters(D)(-1.88 to -7.5), and astigmatism was -0.72±0.43D(-2.00 to -
0.25). Spherical equivalent correction within ±0.50D was achieved in 87 eyes (96.6%).
Postoperative uncorrected (UDVA) was 20/20 or better in 94 eyes(94%). No eye had lost two or more Snellen lines of CDVA. The central cap thickness for all cases was set to 130 μm it was evaluated on day 30 mean achieved central cap thickness was 124,23 μm (SD ± 11,60).
This non-randomized prospective cases series enrolled 90 eyes of 45 patients. All patients underwent uneventful SmartSight lenticule extraction. Preoperatively, mean spherical manifest refraction(MRSE) was -5.1±1.9 diopters(D)(-1.88 to -7.5), and astigmatism was -0.72±0.43D(-2.00 to -0.25). Spherical equivalent correction within ±0.50D was achieved in 87 eyes (96.6%). Postoperative uncorrected (UDVA) was 20/20 or better in 94 eyes(94%). No eye had lost two or more Snellen lines of CDVA. The central cap thickness for all cases was set to 130 μm it was evaluated on day 30 mean achieved central cap thickness was 124,23 μm (SD ± 11,60).

This new femtosecond laser platform (Schwind ATOS) provides a reliable and precise device for refractive laser vision correction. Patients had a quick visual recovery and the UDVA on day 180 was excellent for all patients in this non-randomized study. ATOS represents a new platform for both flap creation and lenticular extraction with very promising early results.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
6

FP22
COMPARISON OF INTRAOPERATIVE SURGICAL FLOW, TOTAL SURGICAL TIME, TIME TAKEN FOR LENTICULE DISSECTION AND SURGEON SATISFACTION FOR SMILE PERFORMED WITH VISUMAX 800 VERSUS VISUMAX 500 FS LASER
Sheetal Brar
Refractive
Sheetal

Brar
India
To compare the intraoperative surgical flow, total surgical time, time taken for lenticule dissection and surgeon satisfaction for smile performed with VisuMax 800 versus VisuMax 500 femtosecond laser
Nethradhama Superspeciality Eye hospital, Bangalore, India
A total of 60 patients who were eligible for bilateral SMILE surgery for myopia correction were included in the study. 30 patients were operated using the VisuMax 800 (operating at a frequency of 2 MHz) and another 30 patients were operated using the VisuMax 500 which operates at the frequency of 500 KHz. Single surgeon operated all cases using a standard surgical technique. Overall surgical flow in terms of completion of the case (average time taken from docking of first eye to removal of lenticule from the second eye), incidence of suction loss, average time taken for lenticule extraction) and surgeon satisfaction score (ranging from 0-5, 5 being highly satisfied) was obtained and compared between the two groups
The average time taken per case in the VisuMax 800 group was 6.2+/-1.4 minutes versus 10.8+/-3.2 minutes in the VisuMax 500 group (p=0.02). The average time required for lenticule removal was 30+/-10 seconds in the VisuMax 800 group, which was not statistically significantly different from the VisuMax 500 group(30+/-16 seconds, p=0.13). The surgeon satisfaction score was significantly higher in VisuMax 800 group( 4.8) versus the VisuMax 500 group(3.9),p=0.05, as the surgical flow was faster and more optimized with the VisuMax 800 laser. No intraoperative complications occurred in either of the group.
The overall workflow and time taken per case was significantly shorter with SMILE performed with VisuMax 800 versus VisuMax 500, due to the higher repetition rate of the laser and robotic arms of the laser and operating microscope, enabling simultaneous docking and lenticule extraction, which translated into improved surgeon satisfaction.

Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
7

FP23
CORNEAL STROMA THICKNESS EVOLUTION AFTER MYOPIC LENTICULAR EXTRACTION ON SCHWIND ATOS
Ivan Gabric
Refractive
Ivan

gabric
Croatia

Evaluate the postoperative behavior of the central corneal stroma thickness and epithelial changes after myopic lenticule extraction by using a combined anterior segment OCT and placido disc topographer, and to compare the accuracy of laser in predicting the actual stromal change.

Eye Clinic Svjestlost, Zagreb, Croatia

Data analysis was performed on 130 eyes from 65 patients who underwent uneventful lenticular extraction. Patient corneas were evaluated with MS39 AS-OCT preoperativley and on day 1, day 30 and day 90 post operativley. Mean attempted manifest refraction was -4.98 D (SD ± 1.18 D), mean attempted cylinder -0.53 (SD ± 0.64). Predicted lenticule tickness was 103 μm (SD ± 13 μm), mean thickness at day 1 was 84 μm (SD ± 20 μm), at day 30 mean thickness was 90.97 μm (SD ± 17.67), at day 90 it was 93.53 (SD ± 19.23).
Schwind ATOS femtosecond laser is predicting a bigger change in maximum lenticule thickness versus the achived thickness. After data analysis of attempted and achived spherical correction (95% within 0.5D) we conculded that the device is overestimating the amount of thissue to be used by about 10% at 90 days.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
8

FP24
A NEW SUCCESSFUL APPROACH FOR EMMETROPIC PRESBYOPIC PATIENTS USING INTRASTROMAL POCKET WITH SMILE MODULE.
Njomza Hima Musa
Refractive
Faruk

SEMIZ
Turkey
To show that near vision improves and patient satisfaction increases by preparing an intrastromal pocket for emmetropic patients with near vision problems using the SMILE module.

Department of Ophtalmology
Eye Hospital
Prishtina
Kosova

This study was performed in Eye Hospital Pristina in 22 eyes of 11 patients aged (40-50) with the emmetropic presbyopic complaint.VisuMax femtosecond laser created the stromal pocket with a diameter 7.60 mm and cap thickness set to 120 μm from corneal surface and with a small opening - 2 mm superior incision at 90° and side cut angle 50°. The pocket was dissected using a blunt spatula.
The patients were followed up for one year with distance, intermediate, and near visual acuity, slit lamp, corneal topography, anterior segment optical coherence tomography. Uncorrected near visual acuity at 35 cm increased from J7 to J2 in 8 eyes operated on, from J8 to J2 in 7 eyes, and from J6 to J2 in 6 eyes. Uncorrected intermediate visual acuity ranged from J4 to J5 at 70 cm, and uncorrected distance visual acuity remained binocular at 20/20. The patients reported satisfaction while reading a book, looking at the phone, and using a computer. No discomfort was observed from the lights while driving at night. We are shaping the surface of the cornea via an introstrımal pocket. We are using the SMILE module without removing the lenticule, and we are just separating the center of the cap from the top of lenticule
In the short term, we have observed increases in spherical aberrations of patients. We also think that corneal shaping has an effect on the presbyopic correction. We will see and analyze the long-term effects by observing them.

This study shows that by preparing an intrastromal pocket for emmetropic patients with near vision problems using the SMILE module, near vision improves, patient satisfaction increases, and it is safe and effective. We think that it would be better to conduct studies that require more patients and longer follow-up in future studies.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
9

FP25
EARLY CLINICAL OUTCOMES FOLLOWING RELEX SMILE PRO WITH THE NEW VISUMAX 800
Supriya Samak Sriganesh
Refractive
Supriya
Samak
Sriganesh
India
To evaluate the early clinical outcomes following ReLEx SMILE PRO using the Visumax 800 in terms of safety, efficacy and intraoperative complications
Nethradhama Superspecialty Eye Hospital, Bangalore
A total of 42 eyes of 21 patients (25.95 ± 2.85 years; mean age ± standard deviation) with a mean spherical equivalent of -3.79 ± 2.33 underwent the ReLEx SMILE Pro procedure using the Visumax 800 machine for correction of myopia. The clinical outcomes were evaluated on post operative day 1 with respect to safety, efficacy and adverse events.
The average pre operative corrected distance visual acuity was -0.07 ± 0.03 logMar, average post operative uncorrected distance visual acuity -0.07 ± 0.06 logMar and corrected post operative distance visual acuity was 0.10± 0.08 logMar. The efficacy index was found to be 1.00 and safety index 1.50. The pre operative OSI was 0.5 and post operative day 1 OSI was 1.135 (p=0.000002). No complications were observed in any of the cases.
Immediate post-op results with the VisuMax 800 demonstrate excellent correction and good visual acuity in terms of efficacy. No eyes had two or more lines loss of CDVA, demonstrating a good safety profile. Quality of vision and interface clarity showed minimal increase in scatter, which is expected to improve over time.

Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
10

FP26
FIRST RESULTS WITH PRESBYOPIA EXCIMER LASER CORRECTION INDUCING HIGHER NEGATIVE SPHERICAL ABERRATIONS IN BLENDEDVISION (PRESBYEDOF)
David Lücht
Refractive
David

Lücht
Germany
The correction of presbyopia by inducing positive (Presbyond, CZM) and negative (PresbyMax, Schwind) sphericalaberrations and blended vision has proven to be efficient. Although the amount of intrapersonal ametropia andoptical approach in both is different.
All surgeries were performed by one surgeon at the Breyer-Kaymak-Klabe Eye Surgery and Premium Eyes in Duesseldorf, Germany, member of the International Vision Correction Research Center (IVCRC.net).
We changed the parameters in treating patients (n=18) with the PresbyMax (Schwind) by inducing targeting emmetropia in the sensoric far dominant eye and -1.5D in the sensoric near dominant eye. Furthermore, we raised the induction of negative spherical aberrations to an EDOF effect of 1.25D - 1.5D. All patients were retrospectively called in a chronological order and answered a questionnaire concerning everyday experience, subjective optical quality, subjective optical side effects and quality of life between 1-3 months after surgery.
In this real-life quality management-controlled investigation of a new surgical approach to correct presbyopia we achieved the following results: The everyday experience, subjective optical quality, subjective optical side effects and quality of life was clinically significant raised in all patients and all of them would recommend it to a friend.
PresbyEDOF is an interesting alternative procedure of suitable excimer laser presbyopia correction in the treatment of patients without cataractogenous lenses.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
11

FP27
ROTATING SCHEIMPFLUG CAMERA TOTAL CORNEAL REFRACTIVE POWER VARIATION BETWEEN 3.0- AND 4.0-MM ZONES
Catarina Praefke Coutinho
Refractive
Catarina
Praefke
Coutinho
Portugal
Analyse the variation of total corneal refractive power (TCRP) from a 3.0 mm and a 4.0 mm diameter ring centered on the pupil axis and its influence on the prediction of residual refractive astigmatism.
Group for Lasers and Plasmas, Institute for Plasmas and Nuclear Fusion, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal; Hospital da Luz Lisbon, Lisbon, Portugal.
Corneal astigmatism and axis measurements calculated via ray-tracing by the rotating Scheimpflug camera (Pentacam, Oculus), for a 3.0- and 4.0- mm zone, were considered for 500 eyes from 376 patients. Astigmatism between zones was assessed for all eyes and for the with-the-rule (WTR) and against-the-rule (ATR) subgroups. Using the N&aelig;ser-Savini Toric Calculator, the toric intraocular lens (IOL) power suggested to be implanted based on the 3.0- and 4.0-mm TCRP values was determined for 125 eyes, randomly chosen for astigmatism differences between zones lower than 0.50 D and including all eyes for higher differences. The predicted residual refractive astigmatism correspondent to the toric IOL power determined to be implanted with TCRP values from the 3.0 mm zone was compared to the prediction for the same toric IOL power but with TCRP values from the 4.0 mm zone.
Mean and standard deviation (SD) astigmatism at the 3.0 mm zone and the 4.0 mm zone for all eyes was, respectively, 1.15±0.83 D and 1.14±0.84 D. For the WTR subgroup these were, respectively, 1.23±0.80 D and 1.25±0.84 D, and for the ATR subgroup 1.19±0.88 D and 1.12±0.84 D. The power of the toric IOL to be implanted changed between zones in 76.80% of the eyes, and from these 52.08% had lower toric IOL powers in the 4.0 mm zone than in the 3.0 mm zone. Considering the toric IOL power determined for the TCRP of the 3.0 mm zone, for astigmatism differences below 0.25 D, between 0.25-0.50 D, 0.50-0.75 D, and 0.75-1.0 D, and higher than 1.0 D, the mean absolute error (MAE) between the correspondent predicted residual refractive astigmatism and the one for the 4.0 mm zone were, respectively, 0.08, 0.26, 0.41, 0.75, 1.09.
Astigmatism changed between the 3.0- and the 4.0-mm zone with an average increase for the WTR subgroup and decrease for the ATR subgroup. The toric IOL power determination changed based on the TCRP of the different zones, mainly decreasing towards the periphery. With the increasing astigmatism difference between zones, also the predicted residual refractive astigmatism difference increased for the toric IOL power determined based on the 3.0 mm zone astigmatism.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
12

FP28
CORNEAL STRAIN INDUCED BY INTRASTROMAL RING SEGMENT IMPLANTATION VISUALIZED WITH THE NOVEL OPTICAL COHERENCE ELASTOGRAPHY
Emilio A. Torres-Netto
Refractive
Emilio A.

TORRES-NETTO
Switzerland
Recently, we reported a novel technique to visualize corneal strain based on optical coherence tomography (OCT) imaging and small-amplitude IOP modulation that permits an evaluation of corneal biomechanics in a condition very close to the eye's natural state. In order to better understand the underlying mechanisms of the ICRS-induced refractive change, it is fundamental to quantify the stress and strain fields provoked by ICRS implantation. Therefore, the purpose of the present study is to record the axial strain field in the cornea directly after creating a stromal tunnel and implanting an intracorneal ring segment (ICRS).
Computer Vision Laboratory, Swiss Federal Institute of Technology, Zurich, Switzerland.
Freshly enucleated porcine eyes were obtained and assigned either to ICRS implantation, tunnel creation only or virgin control. Immediately after manual tunnel creation and ICRS positioning, the entire eye globe was mounted on a customized holder and intraocular pressure (IOP) was adjusted to 15 mmHg. Then, IOP was increased in steps of 1 mmHg to 20 mmHg and decreased again. At each step, an optical coherence tomography volume scan was recorded. Displacements between subsequent scans were retrieved using a vector-based phase difference method. The induced corneal strain direction was determined by taking the axial gradient. In addition, corneal surface was detected and sagittal curvature maps computed.
Corneal tissue presented a localized compressive strain in the direct vicinity of the stromal tunnel, which was independent on IOP change. The central and peripheral (exterior to the ICRS) cornea demonstrated compressive strains upon IOP increase, and tensile strains upon IOP decrease. ICRS induced an annular shaped tensile strain at its inner border, particularly during IOP increase. The compressive strains close to the tunnel remained after ICRS implantation. Corneal curvature changes were concentrated on regions where strain was induced.
For the first time it was possible to obtain strain maps of the corneas after ICRS implantation using optical coherence elastography. ICRS implantation induces localized strains in the regions subjected to refractive changes, suggesting that corneal strain and curvature are directly related. Studying corneal strain in response to surgical intervention may provide new insights on underlying working principles.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
13

FP29
THE IMPACT OF DISTANCE LEARNING DURING HOME CONFINEMENT ON THE INCREASED INCIDENCE OF MYOPIA IN CHILDREN DURING THE COVID-19 PANDEMIC
Sebnem Egriboyun
Refractive
Mustafa Ege

Şeker
Turkey

We investigated the potential impact of increased digital screen time and limited outdoor exposure due to the lockdown measures implemented during the Covid-19 pandemic on the onset of myopia and myopia progression rate in school-aged children in Turkey

A retrospective cohort study in school aged children (7-18 years old) that visited the ophthalmology clinic between the 1st of January, 2014 and the 1st of May, 2021, some of which had visits both before and after Covid-19 pandemic, were made.
Two proportion Z-test was conducted to compare ophthalmology clinic admission rates of myopia before and during lockdown. Myopia progression per day in different time periods was also investigated with Mann-Whitney-U test. Effects of gender and age were analysed with Mann-Whitney-U test and chi-square test respectively.
The myopia admission rate before Covid-19 pandemic was found significantly lower than during the Covid-19 pandemic lockdown (615/4382, 82/249, respectively ,p< 0.01). However, the difference in myopia progression per day between before and during Covid-19 pandemic was not statistically significant for both eyes (right eye p=0.798, left eye p=0.260).
Myopia admission rate to ophthalmology clinics has increased during the Covid-19 pandemic lockdown, suggesting the impact of the presence of distance-learning on recent onset myopia. However, a relationship was not established with the initiation of lockdown and myopia progression rate.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
14

FP30
THE IMPACT OF PART-TIME SPECTACLE CORRECTION ON MYOPIA PROGRESSION: A RANDOMIZED CONTROLLED TRIAL.
Efthymia Prousali
Refractive
Efthymia

Prousali
Greece
To compare myopia progression in Caucasian school-aged children wearing part-time vs. full-time full correction single-vision spectacles.
Paediatric Ophthalmology Outpatient Clinic, 2nd Department of Ophthalmology, Papageorgiou General Hospital, Thessaloniki, Greece.
This prospective, randomized controlled trial included 60 eyes of 30 children with bilateral myopia, who received either full-time, or part-time treatment with single-vision spectacle lenses in both eyes. Myopia progression was assessed as the mean change in cycloplegic spherical equivalent refraction (SE) and as the mean change in axial length (AL), over a 12-month follow-up period. Sub-foveal choroidal thickness (SChT) change was also evaluated over the same period.
A total of 32 eyes were treated with part-time single-vision spectacles (intervention group) and 28 eyes with full-time single-vision spectacles (control group), respectively. The part-time treated group reported no spectacle use during near work activities for a mean of 6.2 hours/day. At the 12-month assessment, there was no difference between part-time and full-time correction groups in mean SE change (mean difference, 0.11 D; 95% CI 0.36-0.58 D; P 0.62). Accordingly, intervention and control groups exhibited similar mean AL change (mean difference, 0.09 mm; 95% CI 0.08-0.27 mm; P 0.28). Part-time and full-time treatment groups were also found to have similar mean SChT change (mean difference, 1.0 μm; 95% CI 24.3-26.4 μm; P 0.94). Of note, paired samples t test showed significant SE change within each group over the 12-month follow-up period.
Myopia progression in school-aged children of Caucasian origin treated with part-time, single-vision spectacle use was found to be significant but not different compared to full-time, single-vision spectacle use, over a 12-month follow-up.
Refractive: Cornea
18.02.2022 08:30
18.02.2022 10:00
15

FP31
‘OFF THE SHELF’ TORIC INTRAOCULAR LENSES (TIOLS) FOR PATIENTS IN THE NATIONAL HEALTH SERVICE: PRELIMINARY DATA OF A RANDOMISED CONTROL TRIAL
Khayam Naderi
Cataract
Khayam

Naderi
United Kingdom
TIOL implantation is associated with additional chair time and financial expenditure, which is important in a public healthcare setting. We present preliminary data of a randomised controlled trial comparing a 'fully-tailored' (FT) TIOLs, and an 'off the shelf' (OTS) approach with 2.00 or 4.00 dioptre cylinder (DC) corrections with additional opposite clear corneal incisions.
Single-centre, prospective single-masked randomised case-controlled trial in a university hospital.
Patients with pre-existing regular corneal astigmatism of 1.50 dioptres or more were recruited. 32 patients have been randomised to the FT group, with 34 patients in the OTS group. Primary outcomes include uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), post-operative refractive cylinder (RC). Secondary outcomes include validated patient reported outcome measures (PROMs) using CATPROM and EQ-5D-3L questionnaires, and adverse events. Follow up was at four weeks and six months.

At 4 weeks, mean UDVA(+/-SD) was 0.17 (0.15) in the FT (n=32) and 0.13 (0.12) in the OTS (n=34) group (p=0.22). Mean BCVA was 0.0022 (0.091) in FT and 0.018 (0.11) in OTS (p=0.52). Mean RC was 0.87 (0.53) in FT, and 0.64 (0.35) in OTS (p=0.044). Mean vector difference (MVC) was 0.87 (0.53) in FT and 0.64 (0.35) in OTS (p=0.044). There were no differences in PROMs between groups. In those patients who have thus far reached 6-month follow-up (FT (n=16) and OTS (n=19)), mean UDVA(+/-SD) was 0.14 (0.16) in the FT and 0.14 (0.15) in the OTS group (p=0.96). Mean BCVA was 0.024 (0.11) in FT and 0.0032 (0.10) in OTS (p=0.57). Mean RC was 0.69 (0.31) in FT, and 0.87 (0.46) in OTS (p=0.19). MVC was 0.69 (0.31) in FT and 0.87 (0.45) in OTS (p=0.19). Patients in the OTS group (-7.13(2.36)) had better CATPROM-5 scores compared to the FT group (-4.59 (2.19)) at six months (p=0.0024) but there was no difference in EQ-5D-3L outcomes.
The use of 'off the shelf' 2.00DC and 4.00DC TIOLs with additional opposite clear corneal incisions may improve UVA and allow patients to achieve spectacle independence for distance vision. Our preliminary data suggests that it may not be inferior to using fully tailored TIOLs.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
1

FP32
REFRACTIVE CATARACT SURGERY WITH A NEW TORIC INTRAOCULAR LENS WITH AN ENHANCED OPTICAL PROFILE AND MODIFIED HAPTICS
Oege Goslings
Cataract
Oege

GOSLINGS
Netherlands
To present clinical data on residual refractive astigmatism, visual acuity (UDVA, CDVA) and toric alignment of the Tecnis Eyhance Toric II intraocular lens IOL (J&J Vision) after implantation in cataract surgery
Departments of Ophthalmology, St. Elisabeth TweeSteden Hospital, Tilburg and Amphia Hospital, Breda, The Netherlands
67 eyes were implanted with a Tecnis Eyhance Toric II IOL with different cylinder powers at the IOL plane (DIU100 n=10, DIU150 n=22, DIU225 n=14, DIU300 n=7, DIU375 n=4, DIU450 n= 4, DIU525 n=6). Outcome measures included residual refractive astigmatism, (un-)corrected distance visual acuity and toric IOL alignment
At 30-90 days postoperatively, the residual refractive cylinder was -0.30 ± 0.33 (DIU100), -0.33 ± 0.30 (DIU150), -0.29 ± 0.26 (DIU225), -0.58 ± 0.29 (DIU300), -0.50 ± 0.46 (DIU375), -0.75 ± 0.20 (DIU450), -0.46 ± 0.33 (DIU525) and -0.42 ± 0.39 (DIU groups combined). UDVA was -0.12 ± 0.13 (logmar) and DCVA was -0.02 ± 0.08 for the DIU groups combined. Degree misalignment was 0.8 ± 1.8 (DIU100), 0.6 ± 1.2 (DIU150), 1.1 ± 2.2 (DIU225), 0.6 ± 0.8 (DIU300), 1.0 ± 1.0 (DIU375), 2.3 ± 2.9 (DIU450), 2.8 ± 4.3 (DIU525) and 1.0 ± 1.9 (range: 0 – 9) for the DIU groups combined
Implantation of the Tecnis Eyhance Toric II IOL seems to be an effective method for astigmatism correction in cataract patients because of low residual refractive astigmatism and an accurate toric alignment profile of this new lens with modified optical profile.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
2

FP33
ROTATIONAL STABILITY OF A TORIC MONOFOCAL INTRAOCULAR LENS WITH AN EXTENDED DEPTH OF FOCUS
Johannes Zeilinger
Cataract
Johannes

ZEILINGER
Austria
The axis alignment of a toric intraocular lens (IOL) is a critical parameter for its efficacy and the patient's satisfaction with the surgical outcome. This study aims to evaluate the rotational stability of a new toric monofocal IOL, which additionally promises an improved postoperative intermediate visual acuity.
Vienna institute for Research in Ocular Surgery (VIROS), Hanusch Hospital Vienna
Prospective, unmasked, single-center study. 50 eyes of 50 patients with regular corneal astigmatism ≥ 0.75 diopters were included into this study. The Tecnis Eyhance Toric II (Johnson & Johnson Vision) IOL was implanted in one eye of each study patient. Pictures of the alignment axis of the IOL were taken intraoperatively, one hour, one week, and 3 months after surgery. Autorefraction and subjective refraction as well as uncorrected and corrected distance (4 meters) and intermediate (66 centimeters) visual acuity were assessed at the 3-months visit. Furthermore a Purkinje meter was used to measure tilt and decentration of the IOL at the last visit.
A preliminary analysis of 37 eyes of 37 patients has shown that the mean absolute error in IOL axis position between the intraoperative and the 1-hour postoperative measurement was 1.8+/-2.1° and 1.2+/-1.0° between the measurements 1 hour and 1 week postoperatively. No statistically significant difference could be detected in axis alignment between the different timepoints (repeated-measures ANOVA, p 0.398) The preoperative CDVA was 0.28+/-0.14 LogMAR and 0.06+/-0.12 LogMar 1 week after surgery (Wilcoxon signed rank test, P< 0.0001). The MAE between aimed and measured spherical equivalent was 0.29+/-0.34 diopters (Wilcoxon signed rank test, P=0.442)
The preliminary results show good rotational stability, corrected distance visual acuity and a small difference between aimed and measured spherical equivalent. The final 1-week and 3-months data of this study will be presented at the ESCRS congress.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
3

FP34
TORIC IOL-CAPSULE TENSION RING SUTURING TECHNIQUE FOR TORIC IOL STABILITY
Fikret Ucar
Cataract
Fikret

Ucar
Turkey
To examine the results of the toric intraocular lens (IOL) and capsular tension ring (CTR) suturing technique in patients with cataract and astigmatism.
Konyagoz Eye Hospital, Department of Ophthalmology, Konya, Turkey
This is a retrospective observational study. Patients who underwent phacoemulsification and toric IOL implantation due to cataract and astigmatism from June 2020 to July 2021 and whose follow-up was completed in the next six months in our clinic were enrolled. In all patients, the CTR-toric IOL complex was co-implanted after the CTR was sutured to the toric IOL haptic using the toric IOL-CTR suturing technique we described previosly (Ucar F, Ozcimen M. Can toric IOL rotation be minimized? Toric IOL-Capsular Tension Ring suturing technique and its clinical outcomes. Semin Ophthalmol. 2021 Jun 6:1-6. doi: 10.1080/08820538.2021.1933545). Preoperative and postoperative astigmatism, corrected distance visual acuity (CDVA), uncorrected visual acuity (UCVA), and IOL rotation were evaluated.
143 eyes of 152 patients were included in the study. The mean age was 63.9 ± 8.5 months. The mean follow-up time was 13.1 ± 5.3 months. There was no significant difference between the postoperative residual astigmatism and the estimated residual astigmatism (p>0.05). Toric IOL rotation was observed in only 2 eyes and it was 10° in both eyes. The mean rotation degree was 0.2° ± 1.4°. The mean preoperative astigmatism was -3.2 ± 1.2 diopters(D) and the mean postoperative residual astigmatism was -0.3 ± 0.3 D (p<0.001).
The toric IOL and CTR suturing technique serves as a rivet for toric IOLs and provides excellent rotational stability. This leads to excellent postoperative visual outcomes and patient satisfaction.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
4

FP35
RAY-TRACING SIMULATIONS WITH AN ASTIGMATIC PSEUDOPHAKIC EYE MODEL AND A GENERIC SIMULATED TORIC IOL
Catarina Praefke Coutinho
Cataract
Catarina
Praefke
Coutinho
Portugal
Evaluation of ray-tracing intraocular lens (IOL) power calculation with a developed astigmatic pseudophakic eye model and generic simulated toric IOL.
Group for Lasers and Plasmas, Institute for Plasmas and Nuclear Fusion, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal; Hospital da Luz Lisbon, Lisbon, Portugal; Studio Oculistico D'Azeglio, Bologna, Italy.
An astigmatic pseudophakic eye model suitable to incorporate patient-specific data was developed based on the Personalized Pseudophakic Eye (PPE) model from Ribeiro and the Liou-Brennan eye model, and implemented in the Zemax®. A generic simulated toric IOL was created, and, assuming a target refraction of zero, the correspondent spherical and cylindrical powers calculated via ray-tracing were compared to the implanted toric IOL powers for 19 eyes and for three models: two pre-operative models, one combined with a PPE based formula for the estimation of the post-operatively lens position, and the other one with the C-Constant by Olsen; and a post-operative model where the lens position was known. Considering the implanted IOL power the difference between the refraction obtained with the post-operative model and the refraction with each of the pre-operative models was determined. The cylindrical power variation was assessed for the scenario where the posterior corneal surface is considered as in the Liou-Brennan eye model, with the keratometric index.
The mean (and standard deviation (SD)) for the spherical and the cylindrical dioptric powers of the known implanted IOL were 19.24 D (3.53 D) and 2.00 D (1.31 D), respectively. For the pre-operative model with the PPE based formula, these were 20.44 D (4.35 D) and 2.04 D (1.82 D), and for the one with the C-Constant formula these were 20.33 D (4.30 D) and 2.04 D (1.80 D). The mean and SD values for the post-operative model were 19.01 D (4.08 D) and 2.06 D (1.86 D). Considering the implanted IOL powers, the mean (and SD) difference between the refraction obtained with the post-operative model and the pre-operative model combined with the PPE based formula was -0.83 D (0.47) for the spherical power and 0.17 D (0.05 D) for the cylindrical power, while combined with the C-Constant formula these were -0.80 D (0.41 D) and 0.16 D (0.05 D). Not considering the posterior corneal measurements led to an increase of the cylindrical IOL power for with-the-rule (WTR) eyes and a decrease for against-the-rule (ATR) eyes.
The created astigmatic pseudophakic eye model with the generic simulated toric IOL showed similar ray-tracing calculated powers to the implanted IOL powers, highlighting the spherical power tenderness to the post-operative IOL position estimations and the cylindrical power relation to the posterior corneal encountering. The implemented model enables simulations of several scenarios encountering patient-specific data.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
5

FP36
OUTCOMES OF TORIC INTRAOCULAR LENS IMPLANTATION USING SWEPT SOURCE OCT BASED BIOMETER ARGOS AND VERION IMAGE GUIDED SYSTEM
João Romano
Cataract
João

Romano
Portugal
To evaluate the outcomes of patients who underwent cataract surgery with the implantation of a toric intraocular lens (IOL) using corneal measurements obtained with a swept source optical coherence tomography (OCT) based biometer ARGOS and surgical orientation with VERION Image Guided System.
Department of Ophthalmology, Hospital de Santo André - Centro Hospitalar de Leiria, Leiria, Portugal
This retrospective study included 49 eyes of 42 patients who underwent phacoemulsification with implantation of a AcrySof® IQ Toric IOL. IOL power calculation was performed using a swept source OCT based biometer ARGOS and VERION Image Guided System was used for surgical orientation. The main outcome measures were corrected distance visual acuity (CDVA), spherical equivalent refraction and residual astigmatism after a 1 to 3-month follow-up period. Vector differences between preoperative and residual refractive cylinder were calculated using the Alpins vector method including target induced astigmatism (TIA), surgically induced astigmatism (SIA), difference vector (DV) and correction index.
Preoperative mean of cylinder was 2.88±1.36 diopters (D) (vector mean 1.73D @ 76.08º) and it decreased significantly postoperatively to 0.62±0.54 D (vector mean 0.33D @ 67.77º). At last postoperative follow-up, CDVA was 8/10 or higher in 80% of the cases and the cylinder was less than 1D in 74% of the cases. The mean vector of the SIA 0.41D @ 49º was slightly lower than the mean vector of the TIA 0.42D @ 60º and the mean DV was 0.17D @99º. Vector analysis of astigmatism showed a correction index of 0.99.
ARGOS biometer and VERION guidance system promoted good postoperative visual results with an effective and predictable implantation of the toric IOL in patients with corneal astigmatism having cataract surgery.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
6

FP37
PREDICTION OF RESIDUAL ASTIGMATISM USING INTRAOPERATIVE WAVEFRONT ABERROMETRY VERSUS MULTIPLE TORIC IOL CALCULATORS
Telmo Cortinhal
Cataract
Telmo

Cortinhal
Portugal
The Barrett Toric IOL calculator offers excellent performance by including estimation of posterior corneal astigmatism and effective lens position. The option of including measured posterior corneal astigmatism is also available. Recently, the Kane Toric formula was introduced. Intraoperative Wavefront Aberrometry (IWA) is an alternative method for intraoperative IOL cylindrical power selection and axis refinement. In this study we compared the prediction of residual astigmatism by each of these methods.
Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra - CHUC, Coimbra, Portugal. Unidade de Oftalmologia de Coimbra (UOC), Coimbra, Portugal.
Prospective study with 60 eyes (60 subjects) implanted with a toric IOL (SN6ATx, Alcon) using IWA (ORA, Alcon) for intraoperative toric power selection and residual astigmatism prediction. Residual astigmatism for the same toric IOL power was back-simulated using the Barrett Toric calculator (with estimated (ePCA) and measured (mPCA) posterior corneal astigmatism), and the Kane Toric formula, using Oculus Pentacam keratometry data. Each suggested toric power by the calculator was noted. Subjective refraction was obtained 3 months postoperatively. The postoperative refractive astigmatism prediction error in the spectacle plane was evaluated by the centroid and the mean absolute error for each method.
The centroid prediction error was 0.15D@175±0.52 for Barrett ePCA, 0.15D@174±0.54 for Barret mPCA, 0.22D@164±0.62 for IWA and 0.24D@179±0.54 for Kane. The Barrett ePCA showed the highest proportion of eyes with a prediction error within 0.50D, 0.75D and 1D with 62%, 90% and 93% (no improvement with mPCA), followed by IWA (50%, 75%, 92%) and Kane (50%, 80%, 92%). The chosen IOL cylindrical power (T) using IWA differed from the suggested IOL cylindrical power using the Barrett ePCA in 35/60 eyes (58%) and from the Kane in 44/60 eyes (57%), with tendency lower T values using IWA compared to the Barrett.
The Barrett Toric calculator had the lowest centroid and mean absolute prediction error. Measured posterior corneal astigmatism did not further enhance these predictions. The IWA device performed slightly better than the Kane Toric formula.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
7

FP38
LONG-TERM VISUAL AND QUALITY OF LIFE OUTCOMES FROM RANDOMIZED CONTROLLED STUDY COMPARING LIMBAL RELAXING INCISIONS VERSUS TORIC INTRAOCULAR LENS IMPLANTATION FOR CORRECTION OF ASTIGMATISM DURING STANDARD CATARACT SURGERY.
Ritika Mukhija
Cataract
Ritika

Mukhija
United Kingdom
To compare the long-term visual outcomes and vision-related quality of life outcomes in patients undergoing limbal relaxing incision/s (LRI) vs toric intraocular lenses (IOL) for astigmatic correction between 0.75 to 2.5 diopters during standard cataract surgery
Tertiary care eye hospital; Randomised clinical control trial
Patients for standard cataract surgery with astigmatism between 0.75D to 2.5D who consented to participate were randomised to receive either LRI or toric IOL. All surgeries were performed by a single experienced surgeon. Patients were assessed pre-operatively and at 1-month, 1 year and 5-years after surgery and a validated questionnaire consisting of 20 questions scored on a 5-category response scale was completed on each visit. Primary outcome measure was uncorrected logMAR distance visual acuity (UCDVA); secondary outcome measures were Quality of Life Impact of Refractive Correction (QIRC) score, best-corrected logMAR distance visual acuity (BCDVA), residual spherical equivalent and refractive astigmatism. Statistical analysis was performed using unpaired 2-tailed t-test and P value<0.05 was considered as significant.
Thirty-four patients toric IOL implantation (group 1) and 36 had LRIs (group 2) during their cataract surgery. Mean age of study population was 73±3 years (M:F=30:40); both groups were comparable in terms of pre-operative axial length, keratometry, astigmatism, UCDVA and BCDVA. For group 1 vs. group 2, mean UCDVA was 0.19±0.19 vs. 0.23±0.24 at 1 month (P=0.43); 0.18±0.20 vs. 0.19±0.20 at 1 year (P=0.85) and 0.21±0.21 vs. 0.18±0.19 at 5 years (P=0.61) respectively. Mean BCDVA was better in group 2 at 1 month (P=0.02); however, there was no statistically sigbificant difference in BCDVA in both groups at 1 year (P=0.51) and 5 years (P=0.18). Residual mean arithmetic spherical equivalent values in group 1 and 2 were -0.08 ±0.69 and -0.15±0.47 at 1 year (P=0.69) and -0.25 ±0.64 and -0.32±0.90 at 5 years (P=0.78). Residual mean arithmetic cylinder values in group 1 and 2 were -0.31 ±0.53 and -0.30±0.50 at 1 year (P=0.97) and -0.81 ±0.51 and -0.77±0.51 at 5 years (P=0.78). Mean overall QIRC scores improved from 47.27±6.34 pre-operatively to 52.43±5.11 at 1-year and 51.06±6.80 at 5 years; sub-group analysis did not reveal any significant difference between the two groups (P>0.05).
Cataract surgery combined with astigmatic correction offered an improvement in quality of life for both groups. Astigmatic correction with LRIs or toric IOLs offers similar 1 year and 5-year visual outcomes for astigmatism between 0.75 to 2.5 dioptres.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
8

FP39
VISUAL OUTCOMES OF BILATERAL IMPLANTATION OF A NEW NON-DIFFRACTIVE EXTENDED VISION INTRAOCULAR LENS (IOL) (ACRYSOF® IQ VIVITY)
Joaquim Neto Murta
Cataract
Joaquim
Neto
MURTA
Portugal
To reports refractive and visual outcomes, spectacle independence, patient -reported outcomes following bilateral sequential bilateral implantation of a non-diffractive extended vision IOL.
1- Department of Ophthalmology, Coimbra Hospital and University Center (CHUC), Coimbra, Portugal
2- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
3 – Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal
4 – Unidade de Oftalmologia de Coimbra (UOC), Coimbra, Portugal
Patients were bilaterally implanted with a non-diffractive extended vision IOL (Alcon Vivity), targeting minimonovision (nearest power for emmetropia in the dominant eye, between -0.25D and -0.50D in the nondominant eye). Post-operative outcome measures included spherical equivalent (SE) determined by subjective refraction, binocular uncorrected distance visual acuity (UDVA), binocular uncorrected intermediate visual acuity – 66 cm (UIVA) and binocular uncorrected near visual acuity -40 cm (UNVA) in photopic conditions, spectacle independence, photic phenomena and Catquest-9SF questionnaires.
148 eyes of 74 patients were included, age 64.58±8.41 years old, 66.22% female (49/74). A toric IOL was implanted in 18.24% of eyes (27/148). Binocular UDVA, UIVA and UNVA was 0.02±0.05, 0.04±0.05 and 0.09±0.09 logMAR, respectively. Mean SE was -0.17±0.20D (min -0.75D, max +0.25D). The refractive targets for minimonovision for dominant and nondominant eyes were met in 90.54% (67/74, SE -0.10±0.16D) and 56.76% (42/74, SE -0.21±0.20D) of cases, respectively. The percentage of patients who reported glasses independence for distance, intermediate and near vision was 90.54% (67/74), 100% and 72.97% (54/74), respectively. No optical phenomena were observed in 93.23% (69/74) of cases. A high patient satisfaction for daily life activities was reported.
Bilateral implantation of this non-diffractive extended vision IOL in a minimonovison strategy provides excellent uncorrected binocular distance and intermediate visual acuities, and even near visual acuity in photopic conditions. This IOL provides high level of patient satisfaction even for very demanding patients, spectacle independence and minimizes unwanted visual effects.

Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
9

FP40
CLINICAL OUTCOMES OF A NEW ENHANCED DEPTH OF FOCUS INTRAOCULAR LENS
Pedro Carreira
Cataract
Pedro

CARREIRA
Portugal
To assess the clinical outcomes and patient satisfaction of the new enhanced depth of focus (EDOF) LuxSmartTM IOL and to compare with a conventional monofocal IOL (AkreosTM) in patients who had undergone bilateral cataract surgery.
Hospital Garcia de Orta
Twelve patients underwent bilateral LuxSmartTM IOL implantation and twelve underwent bilateral AkreosTM IOL implantation. Best-corrected distance (CDVA) and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 66cm, uncorrected near visual acuity (UNVA) at 40cm and defocus curve were assessed. Patients-reported visual function was inquired by Catquest-9SF. The presence of photic phenomena was evaluated. A p-value lower than 0.05 was considered for statistical significance.
The mean IOL power was +21.90D in LuxSmartTM group and +22.30D in AkreosTM. Monocular UDVA (p=0.32) and CDVA (p=0.52) did not differ between groups. The average binocular UIVA (0.18 ± 0.12 logMAR vs. 0.30 ± 0.13 logMAR, p<0.001) and UNVA (0.38 ± 0.14 logMAR vs. 0.44 ± 0.17 logMAR, p=0.02) were higher in LuxSmartTM IOL group. No patients reported disabling photic phenomena in either group.
This study shows that new LuxSmartTM EDOF IOL achieved higher performance for intermediate and near vision compared with a conventional monofocal IOL, without increasing the risk of dysphtopsias. LuxSmartTM may be an attractive and safe option for patients who desire spectacle independence for distance and intermediate vision after cataract surgery.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
10

FP41
PROJECT HYPEROPIC POWER PREDICTION II: THE EFFECTS OF SECOND EYE REFINEMENT METHODS ON PREDICTION ERROR IN HYPEROPIC EYES
Jascha Wendelstein
Cataract
Jascha

WENDELSTEIN
Austria
Evaluating the accuracy of second eye refinement methods in a patient cohort with short axial eye length to assess the performance of IOL power calculation schemes in highly hyperopes.
Augen- und Laserklinik, Castrop-Rauxel, Germany
Single center, single surgeon retrospective consecutive case series. Inclusion of patients after uneventful bilateral cataract surgery implanting either spherical (SA60AT) or aspheric (ZCB00) IOLs. Inclusion criteria were axial eye length ≤21.5 mm and/or emmetropizing IOL power>28.5. Outcome measures were: mean absolute prediction error (MAE), median absolute prediction error, mean prediction error with standard deviation and median prediction error, as well as percentage of eyes with a MAE within 0.25 dpt, 0.5 dpt, 0.75 dpt and 1.0 dpt.
A total of 55 patients were assessed. Refined Kane and refined Okulix provided a smaller MAE compared to other methods. A statistically significant reduction in MAE after second eye refinement was observed for Castrop, Haigis, Hoffer Q, Holladay II, Okulix, Pearl and SRK/T formulae.
In our patient cohort with short axial eye length, second eye refinement led to a lower MAE in almost all formulae. The use of refinement in Kane, Okulix, PEARL-DGS, or Castrop formulae showed the lowest MAE.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
11

FP42
INTRAOCULAR LENS POWER CALCULATION IN SHORT EYES
Emmanuel Neves
Cataract
Emmanuel

Neves
Portugal
To comparatively evaluate the accuracy of newer intraocular lens (IOL) calculation formulas (Barrett Universal II, Kane and Hill-RBF 3.0) and common third-generation formulas with and without using a novel axial length (AL) adjustment in predicting refractive outcomes in eyes with short AL.
Centro Hospitalar e Universitário de Coimbra, Portugal
Retrospective study including eyes with AL less than 22.0 mm submitted to uneventful cataract surgery and implantation of an AcrySof SN60AT IOL. All patients underwent optical biometry (Carl Zeiss IOLMaster 700) and the post-operative spherical equivalent for the same implanted IOL was estimated using SRK/T, Holladay 1, Hoffer Q, Haigis, Barrett Universal II, Kane and Hill-RBF 3.0 formulas. The Cooke-modified axial length (CMAL) method was used in the SRK/T, Holladay 1 and Hoffer Q formulas. Analysis was performed before and after lens constants optimization. Outcomes included the mean (ME) and median (MedE) prediction error, the mean absolute (MAE) and median absolute prediction error (MedAE) and the proportion of eyes within 0.50, 0.75 and 1.00 diopters (D) of the pre-operative prediction.
Sixty-four eyes with a mean axial-length of 21.54 ± 0.57 mm were included. Without adjustment the Hoffer Q was the only formula with a slightly myopic refractive prediction error –0.157D ± 0.60 and Hill-RBF 3.0 had the lowest standard deviation in the prediction error 0.031D ± 0.58. After optimization the mean absolute error in ascending order was Kane 0.43D, Hill-RBF 3.0 0.43D, Barrett 0.44D, Hoffer Q 0.45D, Haigis 0.45D, Holladay 1 0.48 and SRK/T 0.53D. The Kane formula, with the lowest MAE, yielded a prediction error within 0.50D, 0.75D and 1D in 71.9%, 84.4% and 90.6% of cases, respectively. Using CMAL did not improve predictions. The use of optional variables in the Kane (LT and CCT) and Barrett Universal II (LT and WTW) formulas changed the prediction error>0.1D in less than 30% of cases and most without further improvement.
Recent formulas like the Barrett Universal II, Kane, Hill-RBF v3.0 perform well, particularly after constant optimization. Without optimization the Hoffer Q is the only one with myopic prediction error which might explain its popularity in this subset of patients. The CMAL adjustment, originally developed for another optical biometer (OLCR device) did not improve outcomes. Also, the use of optional variables in the Kane and Barrett Universal II formulas did not further enhance predictions.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
12

FP43
EVALUATION OF SELECTED BIOMETRIC PARAMETERS IN CATARACT PATIENTS – A COMPARISON BETWEEN TWO SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY-BASED BIOMETERS
Ewa Mrukwa-Kominek
Cataract
Ewa

Mrukwa-Kominek
Poland
To compare biometry of eyes obtained with two swept-source optical coherence tomography-based biometers: Argos (A) (Movu Inc., Komaki, Japan) and IOLMaster 700 (IM) (Carl Zeiss Meditec, Jena, Germany).
Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Department of Ophthalmology, Professor K. Gibinski University Clinical Center, Medical University of Silesia. Katowice, Polandk
Biometry of 105 eyes of 105 patients before cataract surgery with implantation of intraocular lens were analyzed in this study. Following parameters such as axial length (AL), anterior chamber depth (ACD), lens thickness (LT) from both devices were compared. According to the axial length measurements patients were divided into three groups: group 1 – short eyes (AL<22.5mm), group 2 – average eyes (AL ≥ 26.0 mm) and group 3 – long eyes (22.5 ≤ AL ≤ 26.0 mm). Data were analyzed using Statistica 13.3 software, StatSoft
Statistical significance in axial length was indicated in group of short eyes (n = 26) - mean AL (A) 21,90mm (± 0,59mm) vs AL (IM) 21,8mm ± (0,61mm) (p< 0,001) and in group of long eyes (n = 5) - mean AL (A) 27,95mm (± 2,62mm) vs mean AL (IM) 28,10mm (± 2,64) (p<0,05). In group of average eyes (n = 74) outcomes were similar - mean AL (A) 23,56mm (± 0,70mm) vs mean AL (IM) 23,56mm (± 0,71mm) (p> 0,05). Anterior chamber depth measurements were higher obtained with Argos than with IOLMaster 700 - mean ACD (A) 3,06mm (±0,48mm) vs mean ACD (IM) 2,92mm (±0,46) p< 0,001 There was no statistical significance in mean LT: mean LT (A) 4,75mm (±0,46mm) vs mean LT (IM) 4,72mm (±0,44mm) (p= 0,054). Biometry of one eye with dense cataract could be measured only with Argos using Enhanced Retinal Visualization mode
Axial length measurements with both devices were different in groups of short and long eyes, but comparable in group of average eyes. Anterior chamber depth values obtained with Argos were higher than measurements acquired with IOLMaster 700. Lens thickness measurements were similar with both devices. Eyes with dense cataract could be measured with higher accuracy with Argos than with IOL-Master 700
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
13

FP44
REGRESSION NOMOGRAMS FOR TOTAL CORNEAL POWER ESTIMATION BASED ON OPTICAL LOW-COHERENCE REFLECTOMETRY BIOMETER KERATOMETRY AND COLOR-LED TOPOGRAPHY TOTAL CORNEAL ASTIGMATISM
Catarina Praefke Coutinho
Cataract
Catarina
Praefke
Coutinho
Portugal
Evaluate the prediction error in residual astigmatism associated to generic and astigmatism subgroup specific developed regression nomograms, relating the keratometric astigmatism (KA) measured by the optical biometer (Lenstar LS900, Haag-Streit) with the total corneal astigmatism (TCA) measured by the color-LED topographer (Cassini, i-Optics).
Group for Lasers and Plasmas, Institute for Plasmas and Nuclear Fusion, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal; Hospital da Luz Lisbon, Lisbon, Portugal; University of Toronto, Toronto, Ontario, Canada; Alca&ntilde;iz Hospital, Aragón, Spain.
Development of linear regression formulas for KA measured by Lenstar and TCA measured by Cassini from 637 eyes, adjusting the horizontal and vertical components separately, using double-angles. Generic and astigmatism subgroup specific formulas were considered. For 175 eyes that underwent cataract surgery with toric intraocular lens (IOL) implantation, the measured KA was adjusted using the nomograms and the Abulafia-Koch formula, and the respective prediction errors in residual astigmatism were calculated by vector analysis. For 60 eyes for which the implanted toric IOL was known, the prediction error was also calculated with the Barrett Toric calculator.
Evaluating the 175 eyes, an overall shift towards with-the-rule (WTR) was present. The centroid prediction errors, for all eyes, without adjustment (0.22 D @ 177°) decreased when adjusted with the generic (0.05 D @ 174°) and subgroup specific (0.10 D @ 175°) nomogram adjustment and using the Abulafia-Koch formula (0.17 D@ 91°). Both nomograms decreased the centroid prediction error (p<0.001). For the 60 eyes for which the implanted toric IOL was known, the percentage of eyes with a prediction error within 0.50 D increased from 48.33% without adjustment to 56.67% and 61.67% when adjusted with the generic and specific nomograms, respectively, and to 61.67% and 88.33% with the Abulafia-Koch formula and Barrett Toric calculator, respectively.
Employing the developed regression nomograms based on the KA measured by Lenstar and TCA by Cassini, the prediction error in residual astigmatism significantly decreased in line with other adjustment methods.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
14

FP45
COMPARISON OF CURRENT IOL POWER CALCULATION METHODOLOGIES IN SHORT EYES
Bernardo Feijóo
Cataract
Bernardo

Feijóo
Portugal
To evaluate the accuracy of 8 intraocular lens (IOL) calculation methodologies in short eyes: SRK-T, Haigis, Hoffer-Q, Barret Universal II, Olsen, RBF, Panacea and EVO.
Department of Ophthalmology, Hospital da Luz Lisboa, Portugal and Department of Ophthalmology, Hospital de Alcaniz, Spain
Retrospective case series comparison. We enrolled 122 eyes with axial length equal or inferior to 22 mm. All of them had had routine ocular examination and optic biometry (Lenstar) preoperatively and then underwent phacoemulsification with implantation of a monofocal IOL. We compared the postoperative residual subjective spherical equivalent with the predicted refractive outcome using each methodology.
The mean error was adjusted to zero. The different performances of each methodology were ranked according to standard deviation (SD) of the mean refractive error. The EVO formula had the lowest SD, the lowest absolute median error (0,24D) and the largest proportion of eyes with an absolute error equal or lower than 0,50 D (77,9%). Barret formula had similar results with the same proportion of eyes reaching 0,50 D of the predicted error. There was a statistically significant difference between the Barret formula (absolute median error 0,24 D) and SRK/T (absolute median error 0,31D).
Our results demonstrate that refractive prediction of current IOL power calculation methodologies in short eyes are still inferior to the described for samples with larger axial lengths. Barret formula offers a better performance than SRK/T.
Toric IOLs. Astigmatism Correction. IOL Power Calculations
18.02.2022 10:30
18.02.2022 12:00
15

FP46
EFFICACY AND SAFETY WITH ICL IMPLANTATION: 10 YEARS OF EXPERIENCE
Bernardo Feijóo
Refractive
Bernardo

Feijóo
Portugal
To assess the long-term clinical outcomes of implantation of a posterior chamber phakic intra-ocular lens (Visian implantable Collamer lens [ICL]; STAAR Surgical, Nidau, Switzerland) for correction of myopia and hyperopia after 10 years of experience in our center.
Department of Ophthalmology, Hospital da Luz Lisboa, Portugal
We retrospectively evaluated 412 eyes of 222 consecutive patients who underwent ICL implantation and routine postoperative examinations in one center. 110 lens were ICL model V4, 53 model V4b, 192 model V4c and 57 model V5. 11 eyes had hyperopic refractive errors. Mean preoperative spherical equivalent was -6,10 D (range -20,50 to +7,13 D). Mean follow-up was 27,5 months. Before and 1 and 6 months and 1 to 5 years after surgery we assessed the safety, efficacy, predictability, stability and adverse events of the surgery. Endothelial cell count was evaluated with specular microscopy before and up to 7 years after surgery.
Mean postoperative spherical equivalent refraction at 1 month was -0.22 D, with 96% eyes within +/-1.00 D and 88% eyes within +/-0.50 D of emmetropia. The mean safety index was 1,03. Mean (SD) manifest refraction changes of -0.38 D occurred from 1 month to 5 years after surgery. Endothelial cell count showed a reduction of 5,6% in central endothelial cell density over a 7 years period. 12 eyes (2,91%) developed cataract during the 10 years follow-up. Of these 6 eyes (1,50%) underwent cataract surgery. No vision-threatening complications occurred during the observation period.

Implantation of ICLs is safe and effective and provides predictable and stable refractive results in the treatment of myopia during a 10-year observation period, suggesting its viability as a surgical option for the treatment of such eyes. Our conclusions regarding its use for the correction of hyperopia are limited by the reduced number of cases included.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
1

FP47
EFFICACY AND SAFETY OF POSTERIOR CHAMBER COLLAMER PHAKIC INTRAOCULAR LENS (ICL V4C AND V5) IMPLANTATION FOR LOW MYOPIA
Rui Pedro Silva
Refractive
Rui Pedro

Silva
Portugal
To evaluate visual, refractive and safety outcomes of central-hole posterior chamber collamer phakic intraocular lens (ICL V4C and V5) implantation for low myopia.
Ophthalmology Department, Hospital de Braga, Braga, Portugal
This retrospective cohort study included 106 eyes submitted to posterior chamber collamer phakic intraocular lens (ICL V4C and V5) implantation that completed a 12-month postoperative follow-up. All eyes included were diagnosed with low myopia - spherical equivalent of -6.00D or less. Effectiveness, predictability, stability and safety outcomes were evaluated preoperatively and at 1, 6 and 12 months postoperatively.
Preoperatively, corrected distance visual acuity (CDVA) was 0.04 ± 0.14 logMAR with a manifest spherical equivalent (SE) of -4.89 ± 0.99 D. At 1-year postoperative, logMAR CDVA was -0.01 ± 0.12, with a safety index of 1.13 ± 0.18. Postoperative logMAR UDVA was 0.02 ± 0.17, with an efficacy index of 1.05 ± 0.17, and 74 (69.8%) eyes achieved UDVA of 20/20 or better. After 1 year, manifest SE was -0.16 ± 0.47, with 92 (86.8%) eyes within ± 0.50 D of the target. From 1-month to 1-year, manifest SE change was -0.07 ± 0.25. Intraocular pressure did not change significantly. The mean rate of endothelial cell loss was 1.12%. ICL exchange occurred in one case. No vision-threatening complications were reported.
The posterior chamber collamer phakic intraocular lens implantation demonstrated high levels of efficacy and safety, high refractive predictability and stability, with very low incidence of complications for the treatment of low myopia, and can be considered as an alternative refractive option, especially when corneal ablative procedures are not indicated.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
2

FP48
EFFICACY AND SAFETY OF TORIC POSTERIOR CHAMBER IMPLANTABLE COLLAMER LENS AND TORIC IRIS-FIXATED FOLDABLE PHAKIC INTRAOCULAR LENS IMPLANTATION FOR MYOPIC ASTIGMATISM
Tiago Monteiro
Refractive
Tiago

Monteiro
Portugal
To compare visual, refractive, and safety outcomes of toric posterior chamber implantable collamer lens (T-ICL) and toric iris-fixated foldable phakic intraocular lens (T-Artiflex) implantation for the correction of myopic astigmatism.
Ophthalmology Department; Hospital de Braga
Escola de Ci&ecirc;ncias da Saúde da Universidade do Minho
Retrospective cohort study included 312 eyes of 312 subjects submitted to phakic intraocular lens implantation for myopic astigmatism. Two groups were defined: group 1 comprised 205 eyes that underwent T-ICL implantation; group 2 comprised 107 eyes that underwent T-Artiflex implantation. Safety, efficacy and predictability outcomes were evaluated preoperatively and at 12 months postoperatively. Refractive and corneal astigmatic vector analysis were performed using Alpins method.
One-year postoperatively, uncorrected visual acuity was 0.05±0.18 (T-ICL) and 0.10±0.16 logMAR (T-Artiflex), with efficacy indexes of 1.16±0.27 and 1.05±0.31 (p<0.001). Safety indexes were 1.28±0.30 and 1.21±0.31, respectively (p=0.04). Spherical equivalent was within ±0.5D of emmetropia in 165 (80.5%) and 88 (82.2%) eyes, respectively. Refractive astigmatic analysis showed an index of success of 0.28±0.33 (T-ICL) and 0.31±0.26 (T-Artiflex) (p=0.07). Surgically induced corneal astigmatism was 0.48±0.74D and 0.81±0.61D, respectively (p<0.001). Mean endothelial loss was 1.11% and 2.05%, respectively (p=0.42). Six (2.9%) eyes of T-ICL and one (0.9%) eye of T-Artiflex were submitted to IOL repositioning due to significant lens misalignment. No vision-threatening complications occurred.
Both T-ICL and T-Artiflex showed high visual and refractive efficacy with good safety profile for the correction of myopic astigmatism. T-ICL demonstrated significantly better efficacy and safety indexes at 1-year evaluation. Vector analysis showed similar refractive astigmatic correction in both groups; however, T-Artiflex implantation revealed significantly higher surgically induced corneal astigmatism.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
3

FP49
POSTERIOR CHAMBER PHAKIC INTRAOCULAR LENS IMPLANTATION USING 2.4MM SMALL INCISION
Klaus Wehrmann
Refractive
Klaus

WEHRMANN
Germany
The current standard incision for implantation of phakic posterior chamber intraocular lenses is 2.8mm in width. To reduce postoperative astigmatism and improve refractive results we tested different injectors suitable for 2.4mm IOL implantation in a wet-lab setting using IPCL (Care Group) phakic intraocular lenses. Main targets were finding an injection system with controlled implantation and predictable IOL unfolding characteristics. After positive results in testing we implanted twelve IPCLs using a 2.4mm small incision. Postoperative results were evaluated one day, one week and three month after surgery.
All IPCLs were planed, implanted und followed-up at DrWehrmann Augenheilkunde in Miesbach, Germany.
Injector testing was done using sample lenses equivalent to products for patients. Unfolding characteristics were evaluated in an artificial chamber filled with methyl cellulose.
Six patients had IPCL implantation on both eyes. Alle patients were myopic, two with astigmatism above 0.5 diopters on both eyes, one with monocular astigmatism. Eyes with astigmatism less than or 0.5 diopters were treated with spherical IPCL, above with toric IPCL (IPCLv2 in all cases). The spherical equivalent range was -3.5 up to -14 diopters. Implantation was done using a main 2.4mm incision (Mani MSL24SH) at 90° and two 0.9mm incisions at 45° and 135°. Medicel Ergojet injector was used for IOL implantation. All IOLs were placed on the horizontal 180° axis in the sulcus. Postoperative astigmatism was measured using the Nidek AR360 autorefractor and Heidelberg Anterion anterior segment optical coherence tomography.
IOL unfolding characteristics were favorable in all cases (see video). No IOLs showed defective haptics or other signs of damage after implantation. Postoperative astigmatism on day one in autorefraction was was less than or 1.0 diopter in all cases, less than or 0.5 in six cases. One week and three month after surgery measured astigmatism was less than or 0.75 diopters in all cases. One toric IOL had to be rotated two weeks after surgery. Anterior segment OCT showed usual swelling of the cornea at the main incision on day one after surgery. As far as corneal tomography is evaluable on surgically induced astigmatism, no eye showed noteworthy irregularities sometimes seen with bigger incisions after surgery. Total corneal power stayed within 0.5 diopters of the preoperative values and axis stayed within 6° deviation in all cases.
Safe and predictable phakic IOL implantation was possible in all our cases. Noteworthy surgically induced astigmatism was not present in our twelve cases. As surgically induced astigmatism is hard to eliminate and can be particularly disturbing in refractive cases, we can encourage using a smaller incision in phakic IOL cases, similar to what is already very common in cataract surgery. Still further evaluation with more patients and all lens powers is needed.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
4

FP50
CORRECTION OF LOW AND HIGH ASTIGMATISM WITH POSTERIOR CHAMBER COLLAMER PHAKIC INTRAOCULAR LENS - A COMPARATIVE STUDY
Carlos Cruz
Refractive
Carlos

Cruz
Portugal
To compare the visual, refractive and safety results of posterior chamber collamer phakic intraocular lens (ICL V4C and V5) implantation for the correction of low and high astigmatic refractive errors.
Department of ophthalmology, Hospital de Braga, Portugal.
This retrospective study included 205 eyes submitted to refractive surgery with implantation of posterior chamber collamer phakic intraocular lens (ICL V4C and V5) in Hospital de Braga from 2014 to 2019. Two groups were created according to pre-operative manifest cylinder - low astigmatism (group 1) for those with< 2.5D, which included 97 eyes, and high astigmatism (group 2) for those with ≥ 2.5D, composed of 108 eyes. The two groups were compared regarding efficacy, safety and predictability at 12 months postoperatively. Astigmatic refractive correction was evaluated using Alpins's vectorial analysis.
Mean preoperative manifest cylinder was -1.85 ± 0.27 in group 1 and -3.52 ± 0.95 in group 2. Best corrected visual acuity (BCVA) was 0.10 ± 0.10 and 0.13 ± 0.11 logMAR (p=0.02), respectively. At 12 months of follow-up, the uncorrected visual acuity (UVA) was 0.05 ± 0.10 in group 1 and 0.08 ± 0.12 logMAR in group 2, with no statistical differences between groups (p=0.15). The achieved safety indexes were 1.25 ±0.30 and 1.30 ± 0.29 (p=0.07), respectively. The efficacy indexes were 1.15 ± 0.28 and 1.16 ± 0.26 (p=0.58). The postoperative spherical equivalent was 0.19 ± 0.42 in group 1 and -0.28 ± 0.51 in group 2 (p=0.01). In about 71.1% of cases the manifest cylinder obtained was<0.50D (91.7% achieved<1.00D) in group 1 and 57.5% of cases in group 2 attained<0.50D (81% achieved<1.00D) (p=0.04). The astigmatic vectorial analysis revealed a correction index of 0.91 ± 0.46 in group 1 and 0.89 ± 0.17 in group 2 (p=0.81). The index of success was 0.54 ± 0.45 and 0.29 ± 0.16, respectively (p<0.01). The surgical induced astigmatism was 1.37D ± 0.66 and 2.69D ± 1.00 (p<0.01). The average loss of endothelial cells was 0.85% in group 1 and 1.31% in group 2 (p=0.57). In 2 patients of group 1 and 4 patients of group 2 it was necessary to reposition the lens due to significant postoperative misalignment. No vision threatening conditions were reported.
Correction of astigmatic refractive error with posterior chamber collamer phakic intraocular lens implantation provides good refractive and visual results regardless of the preoperative magnitude of astigmatism, with an excellent safety profile. Using Alpins's vectorial analysis we found a more effective cylinder correction in group 2.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
5

FP51
EVALUATION OF THE ANTERIOR CHAMBER ANGLE BY ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY AFTER IMPLANTABLE PHAKIC CONTACT LENS IMPLANTATION IN MYOPIC EYES.
Mohamed Mahmoud
Refractive
Mohamed

Mahmoud
Egypt
To evaluate the changes in the angle of the AC and lens vault after IPCL implantation by AS-OCT in myopic patients.
A prospective observational study involving 30 myopic eyes in Minia Opthalmology Department
A prospective observational study involving 30 myopic eyes which were implanted with IPCL with AS-OCT was used for evaluation of the anterior chamber angle parameters as anterior chamber angle (ACA), angle opening distance (AOD) and, trabecular iris space area (TISA) and lens vault at 1,3 and 6 months postoperatively.
There were high significant changes between the preoperative values of ACA, AOD and, TISA and first follow-up after 1 month postoperatively with no significant changes between second and third follow-up after 3 and 6 months postoperatively. Regarding the vault, there were stable vault values with no significant changes after 6 months follow-up.
IPCL is a safe method of correction of myopia with stable AC angle narrowing which was monitored by the safe noncontact tool, AS-OCT.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
6

FP52
AFTER PHAKIC INTRAOCULAR LENS EXPLANTATION: A SERIES OF 175 SURGERIES
João Heitor Marques
Refractive
João

Marques
Portugal
To evaluate the indications for phakic intraocular lens (pIOL) explantation, pIOL survival time, visual outcomes and access endothelial cell loss (ECL) after explantation.

Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal.

Chart review was performed for all consecutive patients that underwent pIOL explantation from January 2010 to December 2019 in a single center.
This study included 175 eyes of 112 patients, 77% of which were female. Phakic IOL survival was 12.9 ± 4.8 [3.7 – 28.6] years and the follow-up period after explantation was 4.1 ± 3.0 [0.3 – 9.9] years. The most frequent causes for explantation were cataract formation (44.0%, n=77) and ECL (50.3%, n=88) and there was no difference in survival time accordingly to the cause for explantation (p=0.351). Ten cases (5.7%) were explanted due to uncommon reasons: severe dysphotopsia (n=3), open ocular trauma (n=2) and cataract formation after posterior segment surgery for retinal detachment (RD, n=5). No pIOL was explanted due to ocular hypertension, severe pupil ovalization, glaucoma, intraocular inflammation or non-traumatic pIOL luxation. Posterior chamber pIOL had higher pre-explantation endothelial cell density (ECD) than anterior chamber pIOL (p=0.008), but ECL remained the cause for explantation in 14% of cases with posterior chamber pIOL. During the follow-up period after explantation, mean ECL rate was 2.27 ± 9.32 %/year in the cataract group and -2.14 ± 10.24 %/year in the ECL group, reflecting an increase in cell density in the latter. Moreover, in the ECL group, most cases (60%) showed an increase in ECD during the follow-up and these cases did not differ in age, type of pIOL, preoperative ECD or follow-up period (p>0.077) from the ones that showed a decrease in ECD during the follow-up. Eight eyes (4.6%) required a corneal transplant during the follow-up. Mean corrected distance visual acuity was 0.17 ± 0.24 logMAR at the last visit.

Our study demonstrates that pIOL explantation, after an average survival time of 13 years, is a safe procedure. The main causes for explantation were cataract formation and ECL, in both anterior chamber and posterior chamber pIOL. Most patients show a sustained improvement in visual acuity and stable endothelial cell density after pIOL explantation, and yet its timing should be ideal to avoid irreversible complications.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
7

FP53
COMPARATIVE STUDY OF IRIS-CLAW INTRAOCULAR LENS IMPLANTATION AND IMPLANTABLE COLLAMER LENS – PATIENT-REPORTED OUTCOMES
Matthew Azzopardi
Refractive
Matthew

Azzopardi
United Kingdom
To compare for the first time patient experience and satisfaction of iris-claw implantation to implantable collamer lens (ICL) implantation.
Saint James Eye clinic, a private hospital in Malta specialising in refractive surgery.
A cross-sectional study design with no randomisation or control groups was utilised. Patients who underwent either surgery between 2010 and 2020 were identified from hospital records. Phone interviews were performed in June 2021 using a semi-structured questionnaire, with questions divided into pre-operative build-up, patient experience and post-operative issues. To standardise patient experience a five-point Likert scale was used. Perioperative data was collected from their medical files, and all data was interpreted using SPSS software.
After exclusions, 20 ICL patients (40 eyes) and 17 iris-claw patients (34 eyes) were included. An immediate satisfactory improvement of vision was reported in a higher frequency of ICL patients (n=19, 95%) than iris-claw patients (n=12, 71%) (P=.20054). A higher proportion of the ICL cohort completely agreed that the surgery improved their vision significantly (ICL n=18, 90%; iris-claw n=8, 47%; P=.03318) and that they would recommend it (ICL n=19, 95%; iris-claw n=8, 47%; P=.01468). Postoperative issues were comparable, but iris-claw patients experienced more long-term glare (iris-claw n=8, 47%; ICL n=1, 5%; P<.01). Both techniques completely eliminated contact lens use. Astigmatic ICL patients were more satisfied, with 89%(n=17) completely agreeing that they would recommend the surgery, in comparison to 50%(n=6) of astigmatic iris-claw patients (P=.015).

ICL is superior to iris-claw in terms of patient satisfaction, efficacy and long-term issues, and also in astigmatic patients. Short-term issues were comparable. Both types of surgery succeeded in decreasing contact lens use, further contributing to an improved quality of life. Clinically this could help guide phakic intraocular lens technique selection for better patient satisfaction.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
8

FP54
VISUAL ACUITY, ENDOTHELIAL CELL DENSITY AND POLYMEGATHISM AFTER IRIS-FIXATED LENS IMPLANTATION
Nader Nassiri
Refractive
Kourosh

Sheibani
Iran, Islamic Republic Of
The purpose of this study was to evaluate the visual acuity as well as endothelial cell density (ECD) and polymegathism after iris-fixated lens (Artiflex® AC 401) implantation for correction of moderate to high myopia.
Vanak Ophthalmology Clinic, Tehran, Iran.
In this retrospective cross-sectional study, 55 eyes from 29 patients undergoing iris-fixated lens implantation for correction of myopia (&minus;5.00 to-15.00 D) from 2007 to 2014 were evaluated. Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, ECD and polymegathism (coefficient of variation [CV] in the sizes of endothelial cells) were measured preoperatively and 6 months postoperatively.
In the sixth month of follow-up, the uncorrected vision acuity was 20/25 or better in 81.5% of the eyes. The best-corrected visual acuity was 20/30 or better in 96.3% of the eyes, and more than 92% of the eyes had a refraction score of ±1 D from the target refraction. The mean corneal ECD of patients before surgery was 2,803±339 cells/mm2, which changed to 2,744±369 cells/mm2 six months after surgery (p=0.142). CV in the sizes of endothelial cells before the surgery was 25.7%±7.1% and six months after surgery it was 25.9%±5.4% (p=0.857).
Artiflex iris-fixated lens implantation is a suitable and predictable method for correction of moderate to high myopia. There was no statistically significant change in ECD and polymegathism (CV in the sizes of endothelial cells) after 6 months of follow-up.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
9

FP55
SIMULATED MINI-MONOVISION USING A NON-DIFFRACTIVE EXTENDED VISION INTRAOCULAR LENS – A SYSTEMATIC STUDY OF BINOCULAR DEFOCUS CURVES
Kjell Gunnar Gunnar Gundersen
Refractive
Kjell Gunnar
Gunnar
Gundersen
Norway
To quantify the changes in the binocular defocus curve associated with the Vivity™ non-diffractive extended vision intraocular lens when the dominant eye was targeted for emmetropia and the non-dominant eye was artificially targeted for slight myopia using spectacles.
Private single surgeon clinic
This was a non-interventional research study of the corrected binocular defocus curve associated with binocular emmetropia (Setting A) and with emmetropia in the dominant eye and two different levels of myopia simulated in the non-dominant eye (&minus; 0.50 D, Setting B and- 1.00 D, Setting C). Subjects were patients implanted with the AcrySof® IQ Vivity® intraocular lens in both eyes 3 to 12 months previously. Using the defocus data, the percentage of subjects with a continuous 2.5 D range of vision (distance to 40 cm) was calculated for various levels of minimum visual acuity (VA).
Forty subjects were enrolled. The mean spherical equivalent refraction was- 0.06 D ± 0.36 D, with 0.37 D ± 0.29 D of refractive cylinder. There was no statistically significant difference in the mean VA at- 0.25 D or at- 0.50 D vergences between the test Settings, but there was a statistically significant difference at all other vergences. Differences were particularly noticeable at- 2.00 D,- 2.50 D and- 3.00 D, where higher myopia in the non-dominant eye yielded better binocular VA. A 2.5 D range of functional vision (20/25) was achieved by 38% of subjects at Setting A, 68% of subjects at Setting B and 85% of subjects at Setting C. At setting C, all but one subject (39/40, 97.5%) had a 2.5 D range of vision with a VA of 20/32 or better.
Significant gains in binocular near vision, with only a nominal effect on distance vision, can be achieved with the Vivity IOL by leaving the non-dominant eye of patients with 0.50 D or 1.00 D of myopia.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
10

FP56
SUBJECTIVE VERSUS OBJECTIVE DEPTH OF FOCUS COMPARISON IN AN ASPHERICALLY NEUTRAL MONOFOCAL INTRAOCULAR LENS AND NEGATIVELY ASPHERIC ENHANCED MONOFOCAL INTRAOCULAR LENS.
Dharshana Ramanathan BSc (Hons), MBBS
Refractive
Dharshana

Ramanathan
United Kingdom
To evaluate and compare the subjective versus objective depth of focus (DOF) in pseudophakic eyes implanted with either aspherically neutral monofocal (RayOne Rayner, UK) or a negatively aspheric enhanced monofocal (Tecnis Eyhance, Johnson & Johnson, USA) intraocular lenses (IOLs).
Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton. United Kingdom.
In this prospective, randomised, comparative study, 50 patients (100 eyes) were randomised to receive the same IOL bilaterally. Observations: Follow-ups were at 3-9 months post-surgery. The patients underwent uniocular LogMAR vision for distance and intermediate, refraction, defocus curves and iTrace assessments for objective DOF values. The subjective refraction data of defocus curve were converted to give equivalent DOF measurements. Primary outcome measure: DOF assessed on iTrace versus DOF values derived from defocus curve. Secondary outcome measures: LogMAR unaided distance (UCDVA) and intermediate visual acuity (UIVA) at 66cm, corrected distance (CDVA) and distance-corrected intermediate visual acuity (DCIVA) at 66cm, manifest refraction, pupil size and iTrace aberrometric scan size.
A total of 45 patients were enrolled in the study, of which 22 eyes had the Tecnis IOL and 23 eyes, the RayOne IOL. Subjective assessment of DOF for Eyhance Vs. RayOne 3-9 months were 2.60D±0.67D Vs. 2.09D±0.45D (p<0.01) and objective DOF from iTrace were 1.64D±0.83D Vs. 1.15D±1.37D (p=0.05). Primary outcome measure: Subjective DOF from defocus curve was significantly higher than objective DOF from iTrace in both IOL groups (p<0.01). Secondary outcomes: LogMAR UCDVA & UCIVA was significantly better with Eyhance (0.04 ± 0.09 vs. 0.10 ± 0.12, p= 0.02 and 0.29 ± 0.15 vs. 0.38 ± 0.15, p= 0.02). DCIVA was better with Eyhance (0.27 ± 0.17 vs. 0.37 ± 0.10, p=0.01). Manifest refraction was 0.28D ±0.47 for Eyhance compared to 0.45D ± 0.50 for RayOne (p= 0.13). Pupil size on iTrace was 4.34± 0.50 for Eyhance vs 3.99±0.96 for RayOne (p<0.04). Scan size at 3-9 months was 2.79±0.55 for Eyhance vs 2.69±0.62 for RayOne (p= 0.40).
This study shows that there is a significant difference in subjective and objective assessment of DOF for the two groups of IOLs. iTrace appears to underestimate the depth of focus compared to subjective refraction. This is because the scan size is smaller than the pupil size and the visual axis is not always at the centre of the pupil. Eyhance gave better subjective measurements compared to RayOne with no significant difference in objective measurements. Subjective measurement of DOF appears to be more useful than objective assessment in undilated pupils.

Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
11

FP57
LONG-TERM RESULTS OF SULCUS IMPLANTATION OF A SINGLE-PIECE ACRYLIC INTRAOCULAR LENS FOLLOWING POSTERIOR CAPSULE RUPTURE DURING PHACOEMULSIFICATION
Ana Rita Viana
Refractive
Ana Rita

Viana
Portugal
Implantation of a single-piece-acrylic intraocular lens (SPA-IOL) in the ciliary sulcus during phacoemulsification (PE) surgery complicated with posterior capsule rupture (PCR) is controversial as it can be related to several complications. This study aims to report the long-term results of sulcus implantation of a SPA-IOL.
The present study evaluates the postoperative outcomes and complications of sulcus implantation of a SPA-IOL at the Ophthalmology Department of Hospital Pedro Hispano, Portugal.
Retrospective study of 54 eyes of 54 patients who underwent PE with PCR and sulcus implantation of a SPA-IOL (Akreos Adapt Advanced Optics®, Bausch&Lomb), that were followed for at least 12 months. Recorded data included demographics, IOL centration and postoperative complications. Best corrected visual acuity (BCVA) in logMAR, subjective refraction and intraocular pressure (IOP) were recorded preoperatively, 1-month postoperatively and at last observation.
The mean age was 71.94 ± 10.31 years and the mean postoperative follow-up period was 35.35 ± 21.41 months. Mean preoperative BCVA was 0.78 ± 0.10 logMAR and it significantly improved to 0.22 ± 0.06 logMAR 1-month postoperatively (p<0.001) and 0.30 ± 0.07 logMAR at last observation (p<0.001), without significant differences between 1-month postoperative and final BCVA (p=0.170). Mean preoperative manifest spherical equivalent was -1.12 ± 0.60 Diopter (D), reaching -0.82 ± 0.15 D 1-month postoperatively and -0.77 ± 0.16 D at last examination, without significant differences (p=0.861). Mean IOP was 16.04 ± 0.55 mmHg preoperatively, 15.63 ± 0.73 mmHg 1-month postoperatively and 15.61 ± 0.50 mmHg at last observation (p=0.831). One patient with history of pseudoexfoliative glaucoma required nonpenetrating deep sclerectomy to control postoperative high IOP, precipitated by retained intracapsular cortical fragments and topical corticosteroids. One patient developed secondary glaucoma due to the inflammation from retained intravitreal lens fragments. Two patients (3.7%) started chronic IOP-lowering medications during long-term follow-up time. Postoperatively, 7 eyes (13.0%) showed IOL decentration or subluxation, but only 3 (5.5%) required IOL repositioning. None of the patients developed IOL-associated iris transillumination defects during the follow-up period. Other postoperative complications included posterior capsule opacification in 3 eyes (5.5%), macular edema in 5 eyes (9.3%) and retinal detachment in 4 eyes (7.4%).
Most postoperative complications were expected for a PE surgery complicated with PCR. Postoperative visual results were good and IOL-related complications were few and manageable. Thus, it can be a reasonable option when there are no available backup IOL designed for sulcus placement.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
12

FP58
INTRAOCULAR LENS CALCULATION IN KERATOCONUS PATIENTS – WHICH FORMULA TO USE? WHICH MEASURE OF KERATOMETRIC POWER?
Bruna Cunha
Refractive
Bruna

CUNHA
Portugal
Intraocular lens calculation in keratoconus patients is challenging due to an abnormal ratio of the anterior to posterior corneal power, inaccurate estimations of the effective lens position due to erroneous corneal power measurements, and variable distribution of the corneal curvature along non-orthogonal meridians. Modern formulas were optimized to partially account for these errors. We aim to assess its accuracy in keratoconus patients, and to explore potential advantages of using tomography-derived queratometry and more advanced estimations of corneal power: true net power (TNP) and total corneal refractive power (TCRP).
Refractive Surgery, Ophthalmology Department – Central Lisbon Universitary Hospital Center, Lisbon
Retrospective case series of stage 2 and 3 keratoconus patients who underwent uneventful cataract surgery with in-the-bag implantation of an acrylic hydrophobic spherical IOL. Using ULIB-optimised constants, retrospective constant optimization and measurements from optical biometry, the keratoconus modification of the Kane and Barrett formulas were used to calculate the prediction error for each eye. The same prediction errors using those formulas were calculated using 3 other measures of keratometric power derived from corneal tomography (Pentacam): anterior keratometry, TNP and TCRP (4mm pupil-centered ring). Main outcome measures included mean prediction error (ME), mean (MAE) and median (MedAE) absolute errors in D, and the percentage of eyes within ±0.25, 0.50, 0.75 and 1.00D of the intended refractive target.
A total of 20 eyes from 13 patients were included for analysis. There was a significant difference (p<0.001) between the mean keratometry measured by the Lenstar (53.13±5.72), Pentacam (50.36±2.37), TNP (46.5±1.82) and TCRP (47.68±1.94). The order rank of lowest to highest MAE was: Barrett-Lenstar (1.302), Kane-Pentacam (1.331), Kane-Lenstar (1.338), Kane-TCRP (1.367), Kane-TNP (1.392), Barrett-Pentacam keratometry (1.622), Barrett-TNP (1.968) and Barrett-TCRP (2.038). Only Kane with Lenstar and Pentacam keratometry had standard deviation (SD) errors less than 1; Barrett with Pentacam, TNP and TCRP had the highest SD. Considering MedAE, Barrett-Pentacam (0.711), Kane-Pentacam (1.018), Barrett-Lenstar (1.136) and Kane-Lenstar (1.264) had the lowest values. Overall, refractive accuracy was poor, with only Barrett-Lenstar keratometry achieving more than half (55%, n=11) of patients within ±1.00D of the predicted refractive target.
In a moderate to severe group of keratoconus patients, IOL calculation is challenging, even when using modern formulas optimized for this corneal ectatic disease. When inputting biometric measurements for the keratoconus-modified Kane and Barrett formulas, anterior keratometry derived from both optical biometry and tomography provide acceptable results. In these patients, TNP and TCRP underestimate corneal power, lead to large myopic refractive surprises and therefore are not recommended.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
13

FP59
VISUAL AND REFRACTIVE COMPLAINTS ON PRESBYOPIC PATIENTS OF PORTUGAL
José Salgado-Borges
Refractive
José

Salgado-Borges
Portugal
Evaluate presbyopic Portuguese population habits and eye complaints regarding visual demands as a system to detect potential indications and/or complications of refractive and presbyopic surgery.

ClÍnica Oftalmológica J. Salgado Borges

An email invitation to an online cross-sectional survey was sent to patients from ophthalmology clinics and optical practices in Portugal from September to November 2020. Answers to the questionnaire were analysed using statistical analysis.
833 respondents based in Portugal participated with valid anonymous responses, females 551 (66.1%), and males 282 (33.8%). The most frequent refractive problem was ametropia, astigmatism (47%) and myopia (43%). The first major symptom of presbyopia was difficulty reading smaller letters; 90% had the first symptoms at the age of 40. Almost half of the respondents (45%) were unaware of the 'concept' of presbyopia. More than half of the population (54%) identifies a lot of discomfort caused by increasing of dry eye symptoms according to more intense digital work and lensfogging up when using the mask.

The findings provide an idea of the challenges of refractive and presbyopic surgery. In a society highly dependent on vision, it is essential to focus on signs and symptoms that lead to ophthalmologic conditions. The increased demand for refractive and cataract surgery presbyopic or not and the complications and necessity for detecting dry eye disease before and after surgery are very important to consider nowadays.

Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
14

FP60
BIOMECHANICAL MODELLING OF THE PSEUDOEXFOLIATION SYNDROME IMPACT IN THE LENTICULAR SYSTEM'S ACCOMMODATIVE
Filomena J. Ribeiro
Refractive
Leonor

Jud
Portugal
The study of the crystalline lens complex and its disorders in the context of the scarcity of available clinical and experimental data demands the need for finite element (FE) method studies. The present work has the objective of portraying the relevant features that can lead to the worsening of an individual's visual capacity due to the pseudoexfoliation syndrome. The accommodative capacity of the human lens, when subjected to pseudoexfoliative conditions, is of extreme importance when evaluating the clinical visual capability of the lens.
IDMEC, Instituto Superior Técnico, University of Lisbon; Hospital da Luz Lisbon, Lisbon
Finite element models for a lens complex were developed, composed by the capsule, cortex and nucleus, and anterior, equatorial and posterior zonular fibers. The stretching of the zonules was simulated, from an accommodated to a relaxed state, following Helmholtz's theory of accommodation. Pseudoexfoliative conditions were assessed and analyzed for each individual and group zonular sets. The zonulopathy origin was examined, as well as its extension throughout the composition of the zonular structures. Among other metrics, the amplitude of accommodation of the models was measured by means of dioptric power computation resorting to the Central Optical Power quantity.
With the progression of the disease in the anterio-posterior direction, the accommodative capability becomes more deficient, reaching cases where there is a complete loss of the accommodative capacity. The impact on the amplitude of accommodation was compared between inferior and superior dialysis for the different zonular evaluations. The superior dialysis presents optimal conditions to further the disruption of the fibers and reduce the accommodative amplitude of the lens, when compared with the inferior dialysis location.
This work presents a realistic model of the healthy lenticular system, whilst providing a quantification of the visual accommodative capacity of the lens in healthy conditions and throughout the progression of the pseudoexfoliation disease. The accommodation amplitude of the affected eye becomes an asset when estimating the severity of the syndrome in a patient, given that this quantity can be obtained in a clinical setup. Additionally, the analysis of the severity of the pseudoexfoliation syndrome provides data in the context of the locations that present a greater risk to crystalline lens surgery.
Refractive: Intraocular surgery
18.02.2022 10:30
18.02.2022 12:00
15

FP61
EVALUATION OF A TELEMEDICINE WEB-BASED VISUAL ACUITY E-HEALTH TOOL IN CATARACT PATIENTS
Joukje C. Wanten
Cataract
Joukje

WANTEN
Netherlands
Validation of the Easee web-based tool for the assessment of visual acuity in patients who underwent cataract surgery.
A single-center prospective hospital-based validation study, carried out in the University Eye Clinic Maastricht UMC+.
Subjects, aged between 18 and 69 years old who underwent cataract surgery on one or both eyes at the Maastricht University Medical Center+, were eligible to participate in this study. The uncorrected and corrected visual acuity assessments were performed using the Easee web-based tool (index-test), and conventional Snellen and ETDRS visual acuity charts (reference tests). The outcomes of the different tests were expressed in logMAR and a difference of ≥0.15 logMAR was considered clinically relevant.
A total of 46 subjects with 75 operated eyes were included in this study. The difference between the measurements of the Easee web-based tool and the ETDRS chart had a value of -0.05±0.10 logMAR (p-value= 0.000; [0.15:-0.26]), and -0.04±0.08 logMAR (p-value 0.000; [0.13:-0.21]), for the uncorrected and corrected distance visual acuity, respectively. The Pearson correlation coefficients between these tests were for the uncorrected and corrected visual acuity measurements respectively, 0.94 and 0.89. In total, 82.9% to 88.2% of the visual acuity measurement differences were within the clinically acceptable range.
The Easee web-based tool can be validated for the assessment of visual acuities in patients who undergo cataract surgery when considering a difference of ±0.15 logMAR as clinically acceptable. Future studies need to be conducted to assess the applicability of this tool in regular cataract care.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
1

FP62
MEET DORA: USER ACCEPTABILITY STUDY OF AUTOMATED TELEPHONE FOLLOW UP POST CATARACT SURGERY.
Sarah Khavandi
Cataract
Sarah

Khavandi
United Kingdom
This study explores the patient experience and acceptability of undergoing routine follow up after cataract surgery with an automated telephone call using a natural language artificial intelligence (AI) assistant 'Dora'. The routine pathway of clinician delivered follow up is replaced by Dora who speaks to patients via a regular phone call and delivers a safety check as well as giving the patient the opportunity to ask questions.
This study takes place in the Ophthalmology outpatient department at Stoke Mandeville Hospital Buckinghamshire Healthcare NHS Trust.
This is a mixed-methods cohort study. Patients with planned telephone follow-up after uncomplicated cataract surgery were recruited during June-August 2021. Participants received an automated call between 2-4 weeks post-operatively. All calls were supervised by a human clinician. As part of the conversation patients gave a Net Promoter Score (NPS) in answer to the question 'on a scale of 1 to 10 how likely would you be to recommend this automated service to a friend or colleague?'In addition, a randomly selected cohort of patients also underwent a remote semi-structured interview to assess their opinions about Dora's usability, acceptability, satisfactoriness, and appropriateness. This included the validated Telephone Usability Questionnaire (TUQ) - a likert scale of 16 statements. The qualitative data from the interviews was assessed using thematic analysis.
184 calls were made with Dora (to 178 patients) with a mean age of 78 years. The medianNPS response was 9 out of 10, with a calculated NPS of 46%(number of scores of 9 or 10,minus number of scores below 7, divided by total response number).21 patients had an additional interview. TUQ questions (out of 5) showed high rates of acceptability, with an overall mean of 4.0. Simplicity, time saving and ease of use scored the highest with a median of 5; whilst 'speaking to Dora feels the same as speaking to a clinician' scored a median of 3. Themes that emerged from interview data include convenience, ease of use and patients preference to speak to a clinician for human interaction, or if they were to have a complication.
Dora is an acceptable method of routine follow up post cataract surgery. Whilst many enjoy human interaction, patients appreciate that automation saves time and money for the NHS, and find automated telephone follow up simple and easy to use. Patient views are an integral part of the improvement in design and development of such innovation. With high rates of patient acceptability, the use of automated AI assistants such as Dora has the potential for system wide increase in efficiency of high volume, low complexity care.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
2

FP63
TIME AND MOTION STUDIES TO ASSESS SURGICAL PRODUCTIVITY IN CATARACT THEATRE LISTS WITHIN THE NATIONAL HEALTH SERVICE: IMMEDIATE SEQUENTIAL BILATERAL CATARACT SURGERY VERSUS DELAYED SEQUENTIAL BILATERAL CATARACT SURGERY.
Khayam Naderi
Cataract
Khayam

Naderi
United Kingdom

To compare cataract theatre productivity in the National Health Service (NHS) with back-to-back immediate sequential bilateral cataract surgery (ISBCS) compared to routine case lists consisting of exclusively unilateral cases (UC).
Single-centre, prospective, single-masked randomised case-controlled trial in a university hospital.
Four 4- hour theatre lists with a minimum of three ISBCS cases (3 pairs of eyes) were observed using time and motion studies. The individual tasks and timings of each staff member in theatre was recorded by two observers. The results were compared to previously recorded data in four 4-hours cataract surgery lists in the same hospital consisting of only UC. All operations were performed by consultant surgeons.
The median number of eyes operated per 4-hour list in the ISBCS group was 7.25 compared to 5.75 eyes in the UC group (p=0.032). The median total theatre time (defined as time between the entry of the first patient and the exit of the last patient from theatre) was 130.20 minutes in the ISBCS group and 177.90 minutes in the UC group (p=0.20). The median patient turnover time was 8.70 minutes in the ISBCS group and 15.88 minutes in the UC group (p=0.0001).
Performing back-to-back ISBCS on routine surgical lists appears to increase surgical productivity within the National Health Service. Time and Motion studies are a useful way to investigate surgical productivity and test theoretical models for efficiency improvements.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
3

FP64
EXPLORATION OF IOL-BASED SAFETY EVENTS UTILIZING THE INTERNATIONAL MEDICAL DEVICES DATABASE
Andrew Barton
Cataract
Andrew

Barton
United States
The International Medical Devices Database is a worldwide collection of reports on harmful or inadequately tested medical devices that is assembled by journalists in 36 countries. We sought to utilize this database to assess the sources of intraocular lens-based safety events.
N/A
We conducted a retrospective, cross sectional analysis of 118 intraocular lens-based safety events from 1996-2018 utilizing the International Medical Devices Database.
Of the 118 included safety events, 74 (61%) were recalls, while 28 (23%) were field safety notices. Most of the included safety events were related to devices from the following manufacturers: Abbott Medical Optics, Inc. (22), Carl Zeiss Meditec AG (13), Alcon Laboratories, Inc. (12), Bausch & Lomb (10), and Oculentis GmbH (9). Notably, 61 of the 118 intraocular lens-based safety events (52%) were from European manufacturers. Such safety events have been rising in frequency, with 82 events taking place between 2013 and 2018, compared to only 43 events documented between 1996 and 2012.
Intraocular lens-based safety events have steadily increased over the last 25 years. More investigation is necessary to determine if this rise is due to greater participation in the database, changes in consumer protection regulation, or perhaps a rise in unsafe devices in the market. Greater accountability among the common sources of recalls and field safety notices is needed in order to prevent more unsafe devices from reaching consumers.

Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
4

FP65
CHANGE OF CATARACT PROFILE/CHARACTERISTICS DURING THE COVID-19 ERA: BEFORE AND AFTER THE VACCINATION PROGRAM IN TURKEY
Fahri Onur AYDIN
Cataract
Fahri Onur

AYDIN
Turkey
Investigation of the cataract profile, characteristics, and patient demographics during Coronavirus disease-19 (Covid-19) pandemic before and after vaccination program in Turkey at a single tertiary center.
Cross-Sectional, retrospective, single-center
The medical records of patients who underwent cataract surgery at a tertiary hospital were reviewed retrospectively between May 2020 and October 2021. These patients were divided into 2 groups according to the start date of vaccination in Turkey (Pre-vaccine group - May 2020-January 2021/ Post-vaccine group - February 2021-October 2021). Patients were further categorized into two groups regarding having end stage cataract (mature, hypermature, or morgagnian) or standard cataract.
This study included 1102 patients who underwent cataract surgery. While 232 (21.05%) patients had surgery in the pre-vaccine period, the remaining 870 (78.94%) patients underwent surgery in the post-vaccine period. The mean age of the pre-vaccine group and post-vaccine group was 63.3±12.0 and 64.9±12.0 years respectively (p=0.059). There was no significant difference between the groups in terms of gender (p=0.543). The ratio of end-stage cataracts to all cataracts did not show any difference between the pre-vaccine (12.5%, 29/232) and post-vaccine period (14.4%, 125/870; p=0.466).
This study showed that 2.75 times more patients had the opportunity to have cataract surgery after the vaccination program at a single tertiary center. Despite the increased cataract surgery turnover, the ratio of end-stage cataracts to all cataracts did not show a decrease even 9 months after the start of the vaccination program suggesting that more time might be needed to reach the pre-Covid cataract patient characteristics and profile.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
5

FP66
COMPARISON OF VISUAL OUTCOMES OF A MONOFOCAL, TWO ANDVANCED MONOFOCAL AND TWO EXTENDED DEPHT-OF-FOCUS INTRAOCULAR LENSES
Tiago Bravo Ferreira
Cataract
Tiago
Bravo
Ferreira
Portugal
To compare the clinical outcomes after cataract surgery with the implantation of five different types of intraocular lenses (IOLs): a monofocal IOL (Tecnis 1, J&J Vision), two advanced monofocal IOLs (Tecnis Eyhance, J&J Vision and RayOne EMV, Rayner), and two extended-depth-of-focus (EDOF) IOLs (Tecnis Symfony, J&J Vision and AcrySof IQ Vivity, Alcon).
Hospital da Luz Lisboa, Lisbon, Portugal
In a prospective comparative case series, 258 eyes of 129 patients undergoing cataract surgery were enrolled in 5 groups: Tecnis 1 group (30 patients), Eyhance group (30 patients), RayOne EMV group (15 patients), Symfony group (30 patients), and Vivity group (24 patients). The outcomes in terms of distance, intermediate and near visual acuity (VA), refraction, defocus curve, photic phenomena and spectacle independence were evaluated at 3-months follow-up.
No significant differences between groups were found in monocular uncorrected distance VA (Tecnis 1 0.01±0.08; Eyhance 0.02±0.07; RayOne EMV 0.02±0.09; Symfony 0.03±0.09; Vivity 0.03±0.10; p=0.341). In contrast, significant differences among groups were found in monocular distance-corrected intermediate (Tecnis 1 0.26±0.08; Eyhance 0.16±0.09; RayOne EMV 0.08±0.13; Symfony 0.07±0.11; Vivity 0.06±0.08; p<0.001) and near VA (Tecnis 1 0.48±0.12, Eyhance 0.31±0.09, RayOne EMV 0.26±0.14; Symfony 0.24±0.11; Vivity 0.22±0.13; p=0.003). Significant differences between groups were found in the visual acuity for vergence demands of -0.50, to -3.00 D (p<0.001). Significant differences between the Symfony and the other groups were found in the frequency, severity and bothersomeness of different visual symptoms, including glare and haloes (p=0.044). After surgery, 3.3%, 26.7%, 66.7%, 63.3% and 70.8% of patients did not require the use of spectacles for any distance in the Tecnis 1, Eyhance, RayOne EMV, Symfony and Vivity groups, respectively.
The two advanced monofocal and two EDOF IOLs studied provide an effective visual rehabilitation, resulting in an improved intermediate and near VA, minimal increased incidence of photic phenomena and higher spectacle independence when compared with a standard monofocal IOL.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
6

FP67
INCREASED NEAR VISION SPECTACLE DEPENDENCE OF PATIENTS WITH PREOPERATIVE MYOPIA AFTER MIX-AND-MATCH IMPLANTATION OF TRIFOCAL EDOF AND TRIFOCAL IOLS
Jung Wan Kim
Cataract
Jung Wan

KIM
Korea, Republic Of
To investigate the factors affecting near vision spectacle dependence after mix-and-match implantation of the trifocal extended depth of focus (EDOF) and trifocal intraocular lens (IOL).
Retrospective chart review
A total of 204 eyes of 102 patients who underwent mix- and-match implantation of one trifocal EDOF and one trifocal IOL were enrolled in this study. Patients were divided into two groups according to spectacle dependence for near vision: reading glasses and no glasses. Clinical characteristics were compared between the two groups and multivariate binary logistic regression analysis was performed to determine the odds ratio of factors potentially associated with the need for reading glasses.
Eighty-one patients (79.4%) did not need reading glasses and 21 (20.6%) did. The mean age of the no glasses group (55.6 ± 5.6 years) was significantly higher than that of the reading glasses group (52.7 ± 4.1 years). Preoperative refractions were more myopic in the reading glasses group than in the no glasses group. The postoperative uncorrected near visual acuities were better and the satisfaction scores were higher in the no glasses group compared to the reading glasses group. Multivariate binary regression analysis revealed that only preoperative spherical equivalent (odds ratio: 1.397; P = .025) was related to the spectacle independence for near vision.
Patients who had preoperative myopia and underwent mix-and-match implantation of trifocal EDOF and trifocal IOLs tended to need spectacles for near vision. Surgeons should be aware of patients with myopia when considering mix-and-match implantation of trifocal EDOF and trifocal IOLs.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
7

FP68
ISOPURE: FUNCTIONAL OUTCOMES AND PATIENT SATISFACTION AFTER BILATERAL IMPLANTATION OF A PREMIUM MONOFOCAL INTRAOCULAR LENS.
Rafael Bilbao-Calabuig
Cataract
Rafael

BILBAO-CALABUIG
Spain
ISOPURE (PhysIOL, Liège, Belgium) is an enhanced posterior chamber, premium monofocal intraocular lens (IOL) based on the patented ISOFOCAL concept. The optic displays polynomial complex surface design parameters to extend the Depth of Focus compared to standard monofocal IOLs. The lens is purely refractive and fine-tuned for each dioptric power. The purpose of this retrospective study is to investigate functional clinical outcomes and patient satisfaction after bilateral implantation of ISOPURE IOL during cataract surgery.
Clinical Baviera AIER Group, Madrid, Spain
23 patients (46 eyes) were retrospectively evaluated at least 4 months after cataract surgery and binocular ISOPURE implantation. Emmetropia was targeted in one eye and -0.5-0.75 diopter (D) myopia in the contralateral. Follow-up examinations included: uncorrected and distance-corrected Visual Acuity (UDVA and CDVA), intermediate (UIVA and DCIVA) at 80 and 66 cm, and near (UNVA and DCNVA) at 40 cm. Binocular defocus curves were recorded between -2.5D and +1.5D in 0.5D steps. Binocular contrast sensitivity (CS) was evaluated under mesopic and photopic conditions. Post-operative patient satisfaction and spectacle independence were evaluated with Quality of Life (NEI RQL-42) and PRSIQ Questionnaires.
Mean patients age was 68 years old and mean follow up after surgery was 10.2 months. Mean Log MAR binocular Uncorrected Visual Acuity were as follows: UDVA 0±0.07, UCIVA (80 cm) 0.02±0.08, UCIVA (66 cm) 0.06±0.08 and UNVA (40 cm) 0.2±0.13. Binocular defocus curves confirmed a broad profile and CS curves were within the normal range for the age group. In patients implanted bilaterally, subjective questionnaires indicate high spectacle independence at far and intermediate distances (91%) and no adverse dysphotopic phenomena (92%).
Clinical results show this enhanced monofocal IOL allows patients to experience high-quality vision at far distances and improved useful vision at intermediate distances without inducing undesirable photic effects. A high level of patient satisfaction and a very reasonable spectacle independence outcomes were also obtained. Compared to conventional monofocal lenses, this Premium monofocal IOL shows an improvement in the uncorrected intermediate vision outcomes so often required for many daily tasks.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
8

FP69
FEASIBILITY OF SIMVISGEKKO TO SIMULATE PRESBYOPIC CORRECTIONS PRIOR TO CATARACT SURGERY
Tiago Bravo Ferreira
Cataract
Tiago
Bravo
Ferreira
Portugal
To demonstrate that binocular visual simulators (SimVisGekko; 2EyesVision, Madrid) allow patients to experience and perceive differences in the visual experience provided by different simulated presbyopic corrections before surgery even in the presence of cataracts. To compare the quality of vision preoperatively with different simulations and postoperatively with the corresponding real intraocular lens (IOL) implanted in the same patients. Through this study we also illustrated different patients IOL preferences and the integration of a visual simulator into the clinical workﬂow.
Hospital da Luz Lisboa, Lisbon, Portugal
Binocular defocus curves were evaluated in 19 cataractous subjects (mean age: 58±7 years) preoperatively through 3 different SimVisGekko simulations (the IOL selected by the surgeon and 2 other options) and measured postoperatively in 15 subjects, who had undergone bilateral cataract surgery with the IOL in place. Cataract classiﬁcation was made using the LOCSIII scale. The Multifocal Acceptance Score (MAS-2EV) was evaluated at far for the different corrections. A modiﬁed Catquest questionnaire was completed pre- and post-operatively, as well as a subjective patient feedback questionnaire and a surgeon questionnaire.
In 67% of cases, the corrected distance visual acuity (VA) was equal or better than the VA at 0 D of defocus through the preoperative multifocal simulation. The RMS difference between the mean preoperative simulated and postoperative defocus curve with the IOL implanted was 0.17 D for all the studied IOLs (FineVision, PanOptix and Vivity). Mean MAS-2EV score during daylight and night-time was higher postoperatively for all 3 lenses (PanOptix (p<0.001)). 100% of patients agreed that SimVisGekko concept was easy and 93% agreed that SimVisGekko helped them understand differences between presbyopic correction options.
SimVisGekko™ allows patients with cataracts to experience different presbyopic corrections (including multifocal and modiﬁed monovision) before surgery. Subjects understood better the concept of multifocality through SimVisGekko, helping them to show preferences for a particular solution, which, in most cases, differs amongst individuals. Visual simulators can be implemented in the preoperative clinic workﬂow to improve the selection of presbyopic corrections.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
9

FP70
ONE UNIFORM RASCH SCORING FOR ALL LANGUAGE VERSIONS OF CATQUEST-9SF TO BE USED BY THE EUROPEAN REGISTRY OF QUALITY OUTCOMES FOR CATARACT AND REFRACTIVE SURGERY (EUREQUO)
Mats Lundström
Cataract
Mats

LUNDSTRÖM
Sweden
To calculate one uniform Rasch scoring based on aggregated raw scores from six language versions of Catquest-9SF and to include the uniform Rasch scoring into the EUREQUO system.
This study uses data collected previously in six clinics located in six different countries: Sweden, the Netherlands, France, Germany, Italy, and Denmark.
Patient-reported data was collected by use of Catquest-9SF before cataract surgery. The same procedure was performed with six different language versions of Catquest-9SF in six different countries. Each one of these studies has been published in peer review journals. In the present study we included the raw scores from the six studies into one single file. A Rasch analysis was performed on the aggregated data. The Rasch scoring obtained from the aggregated data was used as a uniform scoring. The uniform scoring will be included in the EUREQUO system as a conversion algorithm from raw scoring and for future use by any clinic collecting Catquest-9SF data irrespective of language.
Altogether 1338 completed preoperative questionnaires were included in the final Rasch analysis. The data fit the Rasch model. The mean age of patients was 74 and 59% were females. Item B (satisfaction with vision) was the most difficult item and the mean item scoring varied in the six language specific analyses between -1.65 and -2.86 logits. In the uniform scoring item B got a score of – 2.25 logits. For the scoring conversion algorithm item B will score -4.83, -2.37, -0.67 and 1.75 corresponding to the raw score 1, 2, 3 and 4, respectively, for the four response options.
A uniform Rasch scoring for different language versions of Catquest-9SF is presented. The advantage of such a scoring is that surgeons don't need to do a new Rasch analysis for new studies. Another advantage is the possibility to compare patient-reported outcomes in different cohorts irrespective of language. A disadvantage is that the uniform scoring is not as exact as a new cohort specific Rasch scoring would be.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
10

FP71
PREDICTORS OF TEAR FILM AND OCULAR SURFACE DISRUPTIONS AFTER CATARACT SURGERY: AN EXPLORATORY STUDY
Lional Raj Daniel Raj Ponniah
Cataract
Lional Raj

DANIEL RAJ PONNIAH
India
To study the various baseline factors contributing ocular surface damage after uneventful cataract surgery and to develop a plan for rational use of ocular surface protectors before and after cataract surgery
A Prospective non-randomised double masked comparative trial in the Dept. of Cataract services
A Prospective non-randomised double masked comparative trial. Cataracts with and without Diabetes were recruited. Preop evaluation of Meibomian gland morphology and the functional tear film with quantitative non-invasive tear meniscus studies, tear break-up time, blink rate were analyzed & compared with 21 days and 3 months post surgery. Ocular Protection Index (OPI) was calculated as a function of ocular surface health by dividing tear break up time by interblink interval and analyzed each visit. OPI of less than 1.0 is considered as ocular surface damage. Using logistic regression model, effects of age & presence of concomitant DM on ocular surface damage post cataract surgery were studied
200 cases enrolled. Mean OPI was 1.3758 at baseline, 0.9738 at 21 days and 1.1038 at 3 months. Repeated measures ANOVA showed significant time effect (p<0.001). Mean blink interval was 7.91 at baseline & 8.82sec by 21 days. Age adjusted DM influence on meibomian gland loss was 12.1% compared to non-DM 6.64%. The logistic regression model was statistically significant, chi square=11.588, P = 0.003. The model explained 23.6% (Nagelkerke R square) of the variance in treatment response and correctly classified 78.5% of cases. Elderly subjects, diabetics were 6.29 & 1.79 times more likely to sustain surface damages than their younger and non diabetic counterparts respectively
Subjects over 60 years of age, irrespective of concomitant DM had borderline OPI & are susceptible to surface damages post cataract. Subjects with DM irrespective of age had borderline OPI & are likely for damages following cataract. Subjects over 60 years with concomitant DM had suboptimal OPI requiring long-term ocular surface protectors
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
11

FP72
VITAMIN D DEFICIENCY AND THE RISK OF CATARACT: A MENDELIAN RANDOMISATION
STUDY
Munisa Hashimi
Cataract
Munisa

Hashimi
United Kingdom
Previous studies have suggested a preventative role in increased serum 25-hydroxyvitamin D levels on age-related cataracts. Other studies have suggested an increased risk of early age-related cataracts in younger patients with vitamin D deficiency (VDD). Unfortunately, many of these studies are limited due to the presence of confounding factors, making the distinction between correlation and causation difficult. Without evidence of causality, it is difficult to establish if an intervention targeting vitamin D levels (VDLs) will be able to prevent cataracts.
To test the causal evidence and estimate the causal effect of vitamin D on cataracts, we used a naturally occurring randomisation experiment, called Mendelian randomisation (MR), which relies on the random allocation of genetic variants in relation to other characteristics at conception.
An epidemiological study of published data.
Information for the genetic predisposition of vitamin D levels and deficiency were obtained from the SUNLIGHT consortium of 79,366 individuals from 31 cohort studies and the UK Biobank of ~500,000 participants which includes 35,076 vitamin D deficient cases (VDLs<25 nmol/L), respectively.
Genetic information for cataracts was obtained from the FinnGen consortium, of 218,792 individuals. Two subcategories of cataracts were tested: senile cataracts and cataracts others.
Four MR analyses were performed between the two vitamin D characteristics (levels and deficiency) and the two cataract categories (senile and others). Additional sensitivity analysis was conducted to test the robustness of the results.
We did not find evidence to suggest that vitamin D deficiency predisposition is associated with either senile cataract, or other forms ([OR= 0.965; 95% CI 0.916 to 1.016, p= 0.170], [OR= 0.993; 95% CI 0.929 to 1.062, p= 0.839], respectively). We were also unable to find evidence that predisposition for vitamin D level is associated with senile cataract or other forms of cataract ([OR= 1.153; 95% CI 0.905 to 1.470, p= 0.249], [OR= 0.947; 95% CI 0.653 to 1.375, p= 0.775], respectively). Our sensitivity analysis did not detect any violations of the MR assumptions that may have influenced our results.
Our results do not support the presence of a modifiable effect of either vitamin D levels or deficiency on cataracts risk. Due to this, we cannot recommend vitamin D supplementation as a preventive measure against cataracts.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
12

FP73
COMPLEX VISUAL HALLUCINATIONS IN PATIENTS REFERRED FOR CATARACT SURGERY.
Mads Assenholt Nielsen
Cataract
Mads Assenholt

Nielsen
Denmark
To investigate the prevalence and clinical characteristics of complex visual hallucinations in patients referred for bilateral cataract surgery.
A single-center tertiary cataract clinic at the department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark.
Three hundred patients were included in this prospective, cross-sectional study. Following a thorough clinical assessment, all participants were screened for visual hallucinations using the same question. Participants responding positively were further questioned about the characteristics of their hallucinatory experiences. Previous medical history was available through digital patient records. Patients with known or suspected cognitive disability or neuropsychiatric disease were excluded, as were patients unable to speak and comprehend the Danish language.
Fourteen (4.7 %) participants reported experiencing complex visual hallucinations (VH). Of these, 8 (2.7 %) saw hallucinations attributable to Charles Bonnet syndrome (CBS), while the remaining 6 (2.0 %) had hypnogogic or hypnopompic hallucinations. Participants who experienced complex visual hallucinations had statistically lower best corrected visual acuity in their best seeing eye compared to participants without hallucinations (mean visual acuity 0.47 (SD 0.20) vs. 0.58 (SD 0.17), p=0.018). No differences were observed in best corrected visual acuity in the worst seeing eye. No significant differences in age, gender or BCVA was observed between participants who experienced CBS and hypnogogic or hypnopompic VH. When participants with a BCVA> 0,3 were excluded, the prevalence of complex VH rose to 10.3 %. One participant with CBS suffered slight distress. Three patients with complex VH had coexisting ocular morbidity: one had glaucoma, two had AMD. Only 15 (5.0 %) patients were familiar with the co-occurrence of complex visual hallucinations due to eye disease, i.e. CBS.
Complex visual hallucinations are frequently observed in patients attending a cataract clinic, even after excluding extraocular conditions known to cause visual hallucinations, e.g. dementia. The prevalence is even higher in patients with poor visual acuity. Considering the ubiquity of cataract in elders, and the possibility of hallucinatory distress and misdiagnosis of VH, it is important to be familiar with visual hallucinations and their potential consequences in patients with cataract.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
13

FP74
PREDICTORS OF POSITIVE DYSPHOTOPSIAS WITH A TRIFOCAL IOL
Arnaldo Espaillat Matos
Cataract
Arnaldo

Espaillat Matos
Dominican Republic
To assess predictive factors associated with glares and halos in patients undergoing cataract surgery with PanOptix trifocal IOL implantation.
Single center retrospective study.
One hundred and fourty eyes from 70 patients with cataract were bilaterally implanted with a trifocal PanOptix aspherical diffractive lens between 2017 and 2019 and followed-up for six months. Both pre- and post-operatively all patients were evaluated for refraction, corneal topography and aberrometry. Patients were assessed at 1 day, 6 days, 1 and 6 months after surgery. One and six months post-operatively patients were asked to complete a satisfaction questionnaire that included dysphotopsias assessment. Main outcome measures were dysphotopsias at 1 and 6 months of follow-up. Predictors of positive dysphotopsias at 1 and 6 months were also analyzed.
A higher corneal coma was associated with more mild halos at 6 months with no association regarding other degrees of severity. The lower the age the higher the glare or halos, the higher the lens thickness and the lower the anterior chamber depth or chord μ the less halos at 1 month. A significant proportion of patients had more none/mild compared to moderate/severe glare and halos both at 1 and 6 months post-operatively. Baseline BCVA was the only predictor of halos at 1 month and glare and halos at 6 months post-surgery.
On multivariate regression analyses the only predictor of positive dysphotopsias was baseline visual acuity, suggesting that patients that have a better visual acuity before surgery are more demanding regarding visual outcomes after surgery.
Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
14

FP75
A NEW APPROACH FOR DETECTING PATIENTS COMPLAINING OF DYSPHOTOPSIA AFTER MULTIFOCAL INTRAOCULAR LENS IMPLANTATION DUE TO NON-OPTICAL REASONS
Joaquín Fernández
Cataract
Joaquín

Fernández
Spain
Positive Dysphotopsia (PD) can be defined as any bothering bright artifact [photic phenomena (PP)] perceived by patients along or around direct bright lights or reflected over objects located in the visual field. The aim of this study was to explore possible methods for detection of poor candidates for Multifocal Intraocular Lens (MIOL) implantation who were complaining about PD in the preoperative period without any optical reason that justified their answer.

Qvision, Ophthalmology Department, VITHAS AlmerÍa Hospital
Eighty-two subjects, aged from 45 to 80 years old, were evaluated during the preoperative screening for presbyopia or cataract surgery, including the following methods of PP measurement: Light Distortion Index (LDI, Light Distortion Analyzer) and a PP gradation simulator (DysphotopsiApp) provided at the same time as the patient experienced the PP by looking at two LED lights. This simulator included a question about the bothersome level of the PP measured on a Likert scale with 5 possible answers from'Not at all' to'Extremely' bothersome. A logistic regression was carried out to determine the cut-off point for the LDI that best predicted the change from a'Slightly' to a'Moderately' bothersome answer. Correlations of LDI with three objective lens sclerosis grading indices were also evaluated: the Ocular Scatter Index (OSI, HD Analyzer), the Ocular Scatter Index (OSI, HD Analyzer), the Lens Dysfunction Index (DLI, iTrace) and the Pentacam Nucleus Status (PNS, Pentacam Wave).
The percentage of patients bothered by the PP were:'Not at all' (22%),'Slightly' (50%),'Moderately' (18.2%) and'Very' (9.8%) bothered. The LDI was significantly correlated with the bothersome question (rho=0.34, p=0.002) and also with OSI (rho=0.67, p<0.0005), DLI (rho=-0.29, 0.007) and PNS (rho=0.48, p<0.0005). The median LDI increased for subjects classified at each of the levels of bothersome, from 7.82% ('Not at all') to 29.13% ('Moderately') bothered. However, the median LDI at the'Very' level decreased to 17.17%. Although the simulator also showed correlations with the bothersome question, no correlations were found with the objective grading methods. The cut-off point that predicted moving from'Slightly' to'Moderately' bothersome was>15.20% for the LDI (ROC AUC=0.64; p=0.05), which could be estimated with the following values of the grading methods:< 2.8 for the OSI,> 7.6 for the DLI and< 2 for the PNS.

The fact that 9.8% of patients'Very' bothered by PP showed a median LDI of 17.17% means that PD could not be explained by the optical components of the eye. Including a question about PD in the preoperative screening together with an objective grading method or direct LDI measurement could help to detect such patients with increased PP discomfort prior to surgery whose discomfort might be increased after MIOL implantation.

Cataract surgery: Оutcomes & New Screening and Dagnostic Modlities. Miscellaneous
18.02.2022 15:15
18.02.2022 16:45
15

FP76
NOVEL DRUG-DEPOSITORY CONTACT LENS THAT LENGTHEN ANTIBIOTIC CORNEAL CONTACT TIME IN BACTERIAL KERATITIS: A RANDOMIZED CONTROLLED TRIAL
Lional Raj Daniel Raj Ponniah
Cornea
Lional Raj

DANIEL RAJ PONNIAH
India
To compare the efficacy of a novel therapeutic contact lens that increases the overall contact time of corneal antimicrobial drug (serving as a drug reservoir) with conventional antibiotic alone treatment regimen in subjects with bacterial keratitis
A Randomized open-label clinical trial, at the Department of Cornea & Ocular Surface Diseases at a tertiary eye care hospital and teaching institution
Bacterial keratitis was randomized into Group-1, treated with a topical antimicrobial, in Group-2, a drug-reservoir contact lens with characteristic dual base curves resulting in a central reservoir alongwith fenestrations to enable capture of topical antimicrobial, was implanted. In both groups, moxifloxacin0.5% in a standard regimen was instituted. Ulcer size, depth, AC reactions, corneal haze were studied. Followed-up on 12 hours, Days-1,3,5 & 14. Pain evaluated on a 10 pt scale. A study on the availability of the drug in the central reservoir was analyzed over a time curve
40 cases were randomised. 3,2 cases in Groups 1 & 2 did not complete the study. Presenting pain were 7.88+/-0.70 in Group-1, 7.67+/-0.78 in Group-2, which reduced by 4.77 points in Group-2 & 1.88 points in Group-1 at Day-1(p<0.001), by 6.13 points in Group-2 by Day-3(p<0.001). Corneal-infiltration (BK severity) on presentation in Group-1 was 2.62+/-0.82mm, in Group-2 was 2.66+/-0.39mm(p=0.92). Resolution by 12 hours in Group-2 was 0.28mm, in Group-1 was 0.04mm, by Day-1 was 0.94mm in Group-2, 0.18mm in Group-1(p=0.03), by Day-3, 1.96 in Group-2 Vs 0.93 in Group-1(p<0.0001), completely resolved in Gr2 within 5 days and within 2 weeks in Gr1. AC-reaction resolved in Group-2 faster within 3-days. Drug availability in reservoir, the potential pre-corneal space was evidenced upto 4 hours
The concept of using a novel drug repository contact lens is effective in prolonging corneal antimicrobial availability and drug contact time over the lesion and has demonstrated in this study that corneal healing hastens, which may affect the overall outcomes in bacterial keratitis. Using a drug-depo contact lens may reduce the regimen of antibiotics, decrease treatment burden on the medical staff, improve patient tolerance, and reduced toxicities, overcoming the loading dose concept
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
1

FP77
CLINICAL PRESENTATION AND OUTCOMES OF CULTURE-PROVEN FUNGAL KERATITIS: A RETROSPECTIVE COMPARISON STUDY BETWEEN FILAMENTOUS AND YEAST FUNGI
Rosa Pinheiro
Cornea
Rosa

PINHEIRO
Portugal
To compare risk factors, clinical features, and management outcomes of culture-proven filamentous and yeast fungal keratitis.
Retrospective comparison study from Coimbra University Hospital, in Coimbra, Portugal.
We identified all cases of fungal keratitis from the microbiologic records between 2005 and 2020 at the Coimbra University Hospital, in Portugal. Demographic data, risk factors, logMAR visual acuity (VA), therapeutic management and functional outcomes were noted. We compared clinical characteristics and treatment outcomes between filamentous (group 1) and yeast (group 2) fungi.
Of the 49 eyes of 49 patients (mean age 59.24 ± 27.8 years) with fungal keratitis, 33 had a filamentous fungus (group 1) and 16 had a yeast fungus (group 2). Patients with filamentous fungi had significantly better VA at presentation (mean VA 1.52 ± 1.02 logMAR in group 1, versus 2.15 ± 0.60 logMAR in group 2; p=0.042) and eyes with yeast fungi had a greater VA improvement following treatment (-0.32 ± 0,73 logMAR in group 2, versus -1.33 ± 1.32 logMAR in group 1; p=0.007). No correlations were found between filamentous and yeast fungi and contact lens use, history of trauma or surgery, corneal perforation, and previous penetrating keratoplasty. Initiation of antifungal therapy within 72 hours of clinical onset was associated with a greater VA improvement (p=0.048).
In this analysis, eyes with yeast fungal keratitis had better clinical outcomes than eyes with filamentous keratitis. Commencement of antifungal therapy within 72 hours of clinical onset was associated with greater VA improvement.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
2

FP78
MICROBIOLOGICAL PROFILE OF INFECTIOUS KERATITIS DURING COVID-19 PANDEMIC
Mário Lima Fontes
Cornea
Mário

Lima Fontes
Portugal
Covid-19 pandemic introduced profound changes in our daily habits, including the frequent use of face masks. Numerous reports from around the world pointed to an increase in dry eye symptoms, due to an upwards route of the exhaled air over the ocular surface. Therefore, we speculated if this mechanism could have led to a change in the microbiological profile of infectious keratitis.
The purpose of this study was to analyze the microbiological results of corneal scrapes from patients with presumed infectious keratitis, in our tertiary center, since March 2020, when the first cases of Covid-19 were identified in Portugal.
Centro Hospitalar Universitário de São João, in Porto, Portugal.
A retrospective study was performed, based on the survey review of electronic medical records of all patients with presumed infectious keratitis, between March 2020 and October 2021. Microbial cultures were performed, and patients were treated according to an internal protocol.
A total of 194 samples from the same number of patients were included. 54% were female patients and the mean age at diagnosis was 49 ± 15 years old.
We obtained a 43.3% culture-positive rate. Bacteria accounted for 83.33% of all positive scrapes (60.71% were Gram positive and 34.52% were Gram negative), fungi for 11.90% and Acanthamoeba for 3.57%. The most frequent agent identified was Corynebacterium macginleyi (22.62%), followed by Staphylococcus aureus and Pseudomonas aeruginosa (16.67% each) and Streptococcus pneumoniae (8.33%).
The most common ophthalmologic risk factors identified were the use of contact lenses (40.7%), previous ocular trauma (8.8%) and history of corneal ulcer (7.7%).
Diabetes (7.7%) and poor systemic status/multiple comorbidities (4.6%) were the most frequent systemic associations.
Most of the microorganisms identified in our sample are known commensals of the upper respiratory tract or pathogenic agents associated with respiratory infections. However, our results did not significatively differ from the ones published by Oliveira-Ferreira et al. in 2019, regarding the microbiological profile of infectious keratitis in our tertiary center from 2009 to 2018. Therefore, the long-term use of face masks doesn't seem to promote significant changes in the microbiological causes of infectious keratitis.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
3

FP79
SHOTGUN METAGENOMIC SEQUENCING IN CULTURE NEGATIVE MICROBIAL KERATITIS
Davide Borroni
Cornea
Davide

Borroni
Latvia
To evaluate the microbiota of culture negative Corneal Impression Membrane (CIM) microbial keratitis samples with the use of shotgun metagenomics analysis
University of Genoa, Italy
DNA of Microbial Keratitis samples was collected with CIM and extracted using the MasterPure Complete DNA and RNA Purification Kit (Epicentre). DNA was sonicated into fragments of 300 to 400 base pairs (bp) using Bioruptor (Diagenode, Belgium) and then used as a template for library preparation. DNA libraries were sequenced on Illumina HiSeq2500. The resulting reads were quality controlled, trimmed and mapped against the humane reference genome. The un-mapped reads were taxonomically classified using the Kraken 2 software.
Eighteen samples of 18 microbial keratitis were collected for the study. CDM were all negative. No DNA was quantified from the extracted negative controls which included 3 empty bijous and 3 CIMs each placed into an empty bijou in a sterile manner to mimic the sampling process in clinical practice.Six out of 18 samples showed the presence of a viral infections. The patients were therefore treated with standard 400 mg Acivlovir 5 time a day and the infections resolved within 3 to 5 weeks. Brevundimonas diminuita was found in 5. Cutibacterium acnes, Staphylococcus aures, Moraxella lacunata and Pseudomonas alcaligenes were also identified as the presumed putative cause of the infection.
Our results confirm that shotgun sequencing can be used as a diagnostic tool in microbial keratitis samples. The possibility to have a clinically useful result in culture negative samples is expanding the available tests to diagnose eye infections.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
4

FP80
TRANS-EPITHELIAL PHOTOTHERAPEUTIC KERATECTOMY (PTK) FOR RECURRENT CORNEAL EROSION SYNDROME (RCES)
Mukhtar Bizrah
Cornea
Mukhtar

Bizrah
United Kingdom
To evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (PTK) as a treatment for recurrent cornea erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments. As far as we know, this is the largest retrospective study to date.
All patients who received PTK treatment for RCES were first vetted and approved by the British Columbia public health insurance authority. A key criteria for approval was failing more than one conventional treatment. 555 patients underwent PTK for treatment for RCES at the Pacific Laser Eye Centre (PLEC). A retrospective chart review and telephone survey were conducted at PLEC.
Patients' sex, age, past ocular history, etiology of RCES, symptoms, visual acuity, interventions trialled prior to PTK, need for retreatment, and time to retreatment were collected in a chart review. Inclusion criteria were patients who received PTK for RCES between 2010 and 2020. Exclusion criteria were patients with ocular comorbidities potentially affecting treatment efficacy including band keratopathy, secondary scarring of the cornea from previous ulceration, Salzmann's nodular dystrophy, granular dystrophy, and Reis-Bückler's corneal dystrophy. 112 patients answered the following in a 10-minute telephone survey: symptoms that led them to seek treatment, the presumed cause of their RCES, efficacy of PTK, therapies trialled prior to and following PTK, and overall satisfcation level.
This study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2 years old) who underwent PTK for RCES. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were occular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). 36 eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing.Post-PTK, 78% of patients did not require any subsequent therapies, 20% required ongoing drops and 6 patients (1.1%) reported no symptom improvement. All 6 eyes were successfully retreated with PTK between 11.3 ± 14.9 months from initial PTK. All study patients showed no significant differences in best corrected visual acuity pre- vs. post-operatively.
When compared to other surgical options, PTK is potentially more costly but frequently more effective and has a high safety profile. The third-party public health vetted nature of this study, the high patient satisfaction, and the low recurrence rate of RCES suggest that a re-evaluation of the role of PTK as an earlier part of standard management of RCES should be considered.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
5

FP81
SHORT TERM CHANGES OF CORNEA AND TEAR FILM AFTER RUTHENIUM-106 PLAQUE THERAPY FOR INTRAOCULAR TUMORS
Navid Abolfathzadeh
Cornea
Navid

Abolfathzadeh
Iran, Islamic Republic Of
To prospectively investigate the short-term effects of Ruthenium 106 (Ru-106) plaque therapy on the cornea and ocular surface parameters.
Tertiary referral eye hospital
Twenty-five patients diagnosed with choroidal melanoma which undergone Ru-106 plaque therapy from 2016 to 2018 were included. Tear osmolarity, tear film break-up time (TBUT), Schirmer test I, fluorescein dye staining based on Oxford staining method; Ocular Surface Disease Index (OSDI) questionnaire and corneal specular microscopy were performed. These tests were assessed preoperatively and then 3 months postoperatively.
The mean(+SD) age of subjects was 48.52±15.18 years. The patients were followed for a mean(+SD) period of 3.64±2.40 months. Total mean(+SD) delivered radiation dose to the tumor apex and total received radiation by the sclera was 83.20±26.31 and 640.65±472.69 Gray (Gy), respectively. In longitudinal analysis, OSDI score and Oxford staining score increased significantly (p=0.002 for both variables) and the prevalence of dry eye disease (DED) increased from 20% preoperatively to 72% at 3 months postoperatively (p=0.001).The changes in the all specular microscopy parameters were statistically non-significant (all p values>0.05).
There is a considerable increase in the rate of DED following plaque therapy for treatment of choroidal melanoma in short-term follow up. The OSDI questionnaire and fluorescein staining test are valuable tools for early detection of DED postoperatively.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
6

FP82
HEALING OF CHEMICAL INJURY RELATED PERSISTENT CORNEAL EPITHELIAL DEFECTS WITH TOPICAL INSULIN
Shafi Balal
Cornea
Shafi

Balal
United Kingdom
The purpose of this study was to evaluate the effectiveness of insulin eye drops for treating refractory persistent epithelial defects (PEDs). A persistent epithelial defect is defined as damage to the corneal epithelium which fails to heal within 2 weeks.
Moorfields Eye Hospital, London, United Kingdom
A prospective, interventional, single-centre, case series was performed from March 2020 to September 2021. All patients were prescribed insulin eye drops on compassionate grounds for the treatment of refractory PEDs, who failed on maximum standard medical (including serum eye drops) and surgical treatment. Patients were prescribed the drops to take four times a day for two months. Patients were followed up at 2 weekly intervals with full slit lamp examination and serial anterior segment photography. The primary end points were the rate and time to resolution of the epithelial defect
11 eyes of 10 patients were treated with insulin eye drops. Mean age of the cohort was 45.4 +25 years with a mean follow-up of 195.7 +114.3 days after re-epithelisation. The most common causative condition was chemical injury (n=5, 60%). Mean PED defect area at initiation of insulin was 41.3 +55.2 mm2. 9 out of 11 eyes (82%) fully re-epithelised within a mean time of 62.3 +34.6 days (range 14-112). In the two patients who did not achieve re-epithelisation, one had a reduction in size from 12.25mm2 to 4.5mm2 and the other had no response. No recurrence in epithelial defect was observed in the group that had fully re-epithelised.
This study showed that the use of topical insulin eye drops led to a successful resolution of PED in 9 of the 11 cases. This is the first reported study to demonstrate the use of insulin drops for closure of PEDs in chemical eye injury. Insulin eye drops may be a safe and cost-effective treatment that adds to the current armamentarium in PED management.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
7

FP83
TOPICAL INSULIN TREATMENT FOR EPITHELIAL DEFECTS IN PATIENTS WITH SEVERE DRY EYE DISEASE AND NEUROTROPHIC KERATITIS.
Enrique Garcia-Soler
Cornea
Enrique

Garcia-Soler
Spain

To evaluate topical insulin treatment in patients with epithelial defects due to severe dry eye disease and neurotrophic keratitis, who had not responded to conventional treatment.

The study was done at Hospital La Fe, Valencia, Spain.
We performed a prospective non-randomized hospital-based study. Patients undergoing topical treatment with insulin eye drops four times a day for treatment of persistent epithelial defects due to severe dry eye disease and neurotrophic keratitis. The healing rate of the epithelial defect was evaluated as well as the decrease in its size.
Twenty patients were treated with insulin eye drops four times a day. They had persistent epithelial defects refractory to multiple medical treatments, including artificial tears, bandage contact lens, autologous serum, 0.1% cyclosporine A and plasma rich in growth factors (PRGF-Endoret). Each patient was dated for checking at a week, 15 days and a month, with complete corneal re-epithelialization within 7 to 30 days.
Insulin eye drops can be a good treatment for patients with persistent epithelial defects despite using conventional treatment. It promotes corneal re-epithelialization and healing. In addition to re-epithelialization and healing, this treatment is tolerated in a very acceptable manner, with few adverse effects; it is not as expensive as other treatments and it is easy to elaborate, ensuring a good availability.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
8

FP84
TOPICAL INSULIN FOR PERSISTENT CORNEAL DEFECTS – AN OLD ACQUAINTANCE WITH A NEW ROLE?
Júlio Almeida
Cornea
Júlio

Almeida
Portugal
To evaluate the effects of topical insulin in patients with persistent corneal epithelial defects that are refractory to the standard treatment.
Prof. Doutor Fernando Fonseca Hospital, Amadora, Portugal
A prospective non-randomized hospital-based study was performed. Patients with different types of persistent epithelial defects refractory to standard treatment were treated with topical insulin 1 U.I./mL 4 times a day. Patient demographics, etiology, and comorbidities were reviewed. The rate of epithelial healing was the considered primary outcome measure.
11 patients (12 eyes) were treated with insulin eye drops (7 females and 4 males; mean age of 65.2 years). Neurotrophic keratitis was the most common cause of persistent epithelial defect (75%), and within this, herpetic eye disease was the main comorbidity (44%). The mean follow-up time was 12.9 weeks. 8 of 12 eyes (66.7%) had complete resolution and 3 of 12 eyes (25%) had significant improvement although the wound didn't fully heal. One patient abandoned the study 2 weeks after due to poor adherence. The mean time of reepithelization for the eyes with full recovery was 27.1 days (range 7-61 days). There were no reports of complications or side effects during the time of the study.
These results suggest that topical insulin could be a good therapeutic alternative for persistent corneal defects due to its good safety profile, availability, and affordability. Because there are few therapeutic alternatives, it may have a promising role as an adjuvant in the management of persistent epithelial defects, possibly avoiding invasive surgical treatments. Highlight that our results are consistent with the published articles. More studies need to be developed to better understand the value of this new field of action for Insulin.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
9

FP85
RESULTS OF A PHASE III, RANDOMIZED, DOUBLE-MASKED, PLACEBO-CONTROLLED STUDY (COSMO) OF A NOVEL 0.05% CYCLOSPORINE A OPHTHALMIC GEL IN THE TREATMENT OF MODERATE TO SEVERE DRY EYE DISEASE
Parag A. Majmudar
Cornea
Parag
A.
Majmudar
United States
The COSMO study aimed to compare the efficacy and safety of a novel 0.05% Cyclosporine A Ophthalmic Gel vs. vehicle in the treatment of patients with moderate to severe dry eye disease (DED).
A prospective, multicenter, randomized, double-blind, vehicle-controlled phase III clinical trial conducted at multiple clinical sites in China
After a 14-day open-label placebo run in period, 644 eligible subjects were randomized 1:1 to receive either 0.05% Cyclosporine A Ophthalmic Gel (CsA Gel) or vehicle nightly for 84 days. Evaluation was carried out on day 14, 42 and 84 consisting of objective measures including corneal and conjunctival staining, Schirmer test and tear film break-up time (BUT) and subjective measures including Eye Dryness Score (EDS) and 6 other symptoms using visual analog scale (VAS). The primary efficacy endpoint was the proportion of patients with a ≥1-point decrease in inferior corneal fluorescein staining score (ICSS) from baseline on day 84. Secondary efficacy endpoints included mean change from baseline in VAS scores for EDS and 6 other dry eye symptoms (burning/pinching sensation, itching, foreign body sensation, discomfort, photophobia, and pain), keratoconjunctival staining score (Oxford grading) measurements, tear secretion test score (Schirmer test, without anesthesia) and Tear Break Up Time (BUT) on day 14, 42 and 84.
The study met the primary efficacy endpoint of a ≥1-point decrease in ICSS in 73.7% of the treatment group vs 53.2% of the control group (P<0.0001) at day 84. Mean change in ICSS from baseline on day 84 of treatment group was significantly superior to that of control group (-1.3 vs -0.8, P<0.0001). CsA Gel also significantly improved keratoconjunctival staining (Oxford scale, P=0.0076) and tear secretion (Schirmer test score, P=0.005) on day 84. The EDS scores were significantly improved compared with baseline on day 84 in the treatment group (P<0.001), and there was no such significant difference in the vehicle group (P=0.313). The BUT on day 84 was significantly improved compared with the baseline in the treatment group, but not in the vehicle group (P=0.7086).
CsA Gel 0.05% once a day significantly reduced corneal and conjunctival staining and improved tear secretion compared with the control group in moderate to severe DED. It also significantly alleviated symptoms compared with baseline. CsA Gel will be a new efficacious, safe and well tolerated therapeutic option that might bring additional benefits of convenience and compliance as a once-a-day treatment for moderate to severe dry eye.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
10

FP86
CORNEAL ENDOTHELIAL CELL CHARACTERISTICS IN PATIENTS WITH DRY EYE DISEASE
Medine Gündoğan
Cornea
Medine

Gündoğan
Turkey
This study aimed to evaluate corneal endothelial cell characteristics in patients with dry eye disease (DED) compared to an age- and gender-matched healthy control group.
Health Science University, Kayseri City Hospital, Department of Ophthalmology, Kayseri, Turkey.
This Cross-sectional, controlled study included 59 eyes of 59 patients with moderate-to-severe dry eye disease (31 male, mean age 51.8 ± 6.2 years old) and 53 eyes of 53 normal controls (24 male, mean age 50.5 ± 6.9 years old). All individuals underwent a complete ophthalmic examination including symptom assessment using the Ocular Surface Disease Index (OSDI), corneal fluorescein staining, and tear breakup time (TBUT). In vivo specular microscopy was performed to assess the following parameters in the central cornea: endothelial cell density, coefficient of variation, and hexagonality.
Endothelial cell density was significantly lower in patients with dry eye disease (2389.8 ± 279.3 cells/mm2) compared to the healthy controls (2556.8 ± 347.7 cells/mm2) (P=0.046). Coefficient of variation was significantly higher (40.6% ± 7.8) compared to the healthy controls (37.5% ± 6.9) (P=0.030), whereas hexagonality was significantly lower in patients with dry eye disease (51.5% ± 9.2) compared to the healthy controls (55.7% ± 9.6) (P=0.021). Pearson correlation analysis showed that there were statistically significant negative relationship between corneal ECD and dry eye severity parameters including the OSDI score (r=-0.32, P=0.020), corneal fluorescein staining (r=-0.29, P=0.01), and TBUT (r=-0.30, P=0.005).
Dry eye disease may cause a significant changes in corneal endothelial cell characteristics which correlates with clinical severity of the disease. Cases with pre-existing endothelial damage, such as those currently with low ECD or following intraocular procedures, should be evaluated for endothelial loss due to DED as well as DED.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
11

FP87
INFLUENCE OF DRY EYE DISEASE (DED) TREATMENT WITH LIPIFLOW® ON CORNEAL TOPOGRAPHIC AND ABERROMETRY MEASUREMENTS
Peter Pego
Cornea
Peter

Pego
Portugal
To evaluate the influence of Dry Eye Disease (DED) treatment with LipiFlow® on corneal topographic and aberrometry measurements.
Single center prospective study.

20 eyes of 10 patients with DED were analyzed. Before and 1 month after DED treatment with LipiFlow® patients were asked to complete the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. All patients were evaluated for breakup time test (BUT) and corneal topographic and aberrometry measurements with Cassini® topographer, Orbscan® II topographer and Zywave® II wavefront aberrometer, before and 1 month after DES treatment with Lipiflow®. Given most variables were non-normally distributed, the non-parametric Wilcoxon test was used to compare pre- vs post-treatment assessments. Statistical significance was set at p<0.05.
When comparing pre- vs post-treatment assessments, DED symptoms (lower SPEED score; n=20, 12.6 vs 5.7, p<0.001) and signs (higher BUT; n=20, 4.35 vs 9.05, p<0.001) improved one month after LipiFlow® treatment. On the other hand, 5mm zone astigmatism power at Orbscan® II increased after treatment (n=20, 1.21 vs 1.37, p=0.023) and Cassini® Surface Indices high order aberrations HOA (n=16, 1.09 vs 0.49, p=0.002) and surface asymmetry index SAI (n=16, 1.39 vs 0.59, p=0.002) decreased after treatment. None of the other analyzed variables showed statistically significant differences from pre- to post-treatment.
LipiFlow® seems to be effective in DED treatment with improvement in both symptoms and signs. DED treatment seems to influence the accurate acquisition of topographic and aberrometry parameters, particularly in the measurement of astigmatism and improving Surface Indices, such as HOA and SAI. The acquisition of accurate corneal topographic and aberrometry values is essential in both refractive surgery and cataract surgery. These results highlight the role that DED treatment can play in obtaining more accurate ocular surface values.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
12

FP88
COMPARISON OF THE TEAR FILM STABILITY AND COMFORT LEVELS OF A NOVEL AND TWO CONVENTIONAL DAILY DISPOSABLE CONTACT LENSES IN HEALTHCARE PROFESSIONALS WHO HAD TO WEAR FACIAL MASKS FOR PROLONGED PERIOD OF TIME.
Ayşegül Penbe
Miscellaneous
Ayşegül

PENBE
Turkey
Due to the Covid -19 pandemic, the need for switching glasses to contact lenses (CLs) was more common for healthcare professionals due to fogging and sterilization problems. We aimed to clarify the most appropriate daily disposable contact lens (DDCL) material in terms of tear film stabilization and ocular comfort levels for prolonged use.
A randomized, prospective and comparative study.
The healthcare professionals between 18-40 years old who wanted to wear CL as first-time users were randomly included to the 3 study groups (group 1: verofilcon A, Precision 1®, Alcon, group 2: nesofilcon A, Biotrue® Oneday, B&L, and group 3: senofilcon A, Acuvue Oasys®1-Day, J&J. The patients were evaluated initially and after 2 weeks of CL use with contact lens corrected visual acuity (CLCVA), keratometry, non-invasive tear break up time (NITBUT) scores at first, 4th, 8th, and 12th hours, high order aberrations (HoAs) scores obtained from Sirius Corneal Topography, and Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) scores for comparative analysis.
Between August and September 2021, 65 eyes of 33 subjects included to the three study groups of the ongoing study completed the final visit. The initial CLCVA, keratometry, NITBUT and HoAs mean values were similar. After 2 weeks of CL use; the measurements were evaluated while the contact lenses were on the ocular surface. The mean values of CLCVA, keratometry, NITBUT and HoAs at first and 4th hours of wearing CLs were similar again. At the 8th hours of wearing CLs the mean NIBUT scores (Group1: 10.23 seconds (sec), Group 2: 9.74 sec, Group 3: 8.15 sec) were lower in group 3 (p= 0.027). However, at the 12th hours the mean scores of NITBUT scores were recorded as 8.72 sec in group 1, 5.91 sec in group 2 and 4.06 sec in group 3, and statistically meaningfully higher in group 1 according to the other two groups (p=0.016). The mean HoAs scores were similar at 8th hours but at 12th hours group 3 had the highest scores (p=0.036) and the group 1 had slightly lower scores than group 2 (p=0.067). The CLDEQ-8 scores were significantly lower in group 1 and group 2 (6.18, 7.23 and 9,82, respectively). (p=0.042)
The preliminary results of the ongoing study suggest superiority of the tear film stabilization capability of verofilcon A in prolonged use. The better scores of this lens at the 12th hours could be explained with a new and unique surface technology named SMARTSURFACE™ presenting a greater than 80% water content to maintain a stable pre-lens tear film. The higher CLDEQ-8 and HoAs scores of nesofilcon A could be depending on to the higher dehydration rates of the hydrogel CL materials compared to the silicon hydrogels CLs.

Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
13

FP89
EFFECT OF TREATMENT WITH TOPICAL AZITHROMYCIN OR ORAL DOXYCYCLINE ON TEAR FILM THICKNESS IN PATIENTS WITH MEIBOMIAN GLAND DYSFUNCTION – A RANDOMIZED, ACTIVE CONTROLLED, PARALLEL GROUP STUDY
Andreas Schlatter
Miscellaneous
Andreas

SCHLATTER
Austria
Aim of this randomized, active controlled, parallel group study was to compare the effect of topical azithromycin and oral doxycycline on tear film thickness (TFT) and signs and symptoms of ocular surface disease (OSD) in patients with meibomian gland dysfunction (MGD).
All study-related measures as well as data collection were performed at the Department of Clinical Pharmacology and at the Centre for Medical Physics and Biomedical Engineering of the Medical University of Vienna.
Patients with MGD were randomized to either receive topical azithromycin (Azyter® 15 mg/g, one drop twice daily in both eyes for two days, then once daily for 26 days) or oral doxycycline (Doxycycline Genericon 100 mg, twice daily for six weeks). In total, four study visits at intervals of two weeks were scheduled. Main outcome of the study was change in TFT as measured with ultra-high resolution optical coherence tomography (UHR-OCT). Ocular Surface Disease Index (OSDI), composite sign score for OSD, lipid layer thickness (LLT), tear film osmolarity, conjunctival staining as assessed with Lissamine green and Schirmer Test I served as secondary outcomes.
Twenty patients were included in the final analysis. TFT significantly increased in both groups (p = 0.028 vs. baseline) with no difference between the two groups (p = 0.096 between groups). Additionally, OSDI score and composite signs of OSD significantly decreased in both groups (p = 0.023 for OSDI and p = 0.016 for OSD signs vs. baseline). There were no significant changes in LLT, tear film osmolarity, conjunctival staining or Schirmer test I. Systemic adverse events (AEs) were more frequent in the doxycycline group, while in the azithromycin group mainly local AEs occurred.
Treatment with both topical azithromycin and systemic doxycycline improved signs and symptoms of OSD in patients with MGD. There was no difference between the two treatment groups. Topical application of azithromycin seems to be an alternative to systemic doxycycline, as systemic side effects are less common.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
14

FP90
CHANGES IN CORNEAL BIOMECHANICAL PROPERTIES AFTER PENETRATING CORNEAL INJURY
Cansu Demircan
Cornea
Cansu

Demircan
Turkey
To examine the changes in corneal biomechanical properties after healing in penetrating corneal injuries and to compare the data with the healthy eyes.
Cross-sectional study.
Patients with penetrating corneal injury and the time elapsed after surgical repair were at least 6 months were included in the study. Corneal biomechanical properties were evaluated with Corvis® ST ([Oculus, Wetzlar, Germany], dynamic corneal response parameters, Vinciguerra analysis). Demographic data, time since the operation, examination findings, two different intraocular pressure (IOP) measurements (Goldmann applanation tonometry [GAT] measurement and biomechanically corrected IOP [bIOP]) and corneal biomechanics data were recorded. In the statistical analysis, the data of the eyes with penetrating corneal injury and the healthy eyes were compared.
Fifteen eyes of 15 patients (3 females, 12 males) with a mean age of 50.47 ± 10.3 years (33 –62 years) who underwent penetrating corneal injury repair were included in the study. A control group was formed with the other healthy eyes (n=15) of the same cases. The mean time since penetrating injury repair was 48 ± 30 months (10-100 months). The stiffness parameter in the first applanation point (SP-A1) values were lower in eyes with penetrating injury repair than those in the healthy eyes (p=0,004). There was a moderate negative correlation between the time elapsed after penetrating injury repair and the length of the applanated cornea in the second applanation point (A2 Length) (r = -0,71, p = 0,003). In addition, a negative correlation was found between the size of the penetrating injury and the deformation amplitude (DA) and integrated radius values (r = -0,608, p = 0.016 ; r = -0,611, p = 0,015, respectively). In healthy eyes, biomechanically corrected IOP values were higher compared to GAT measurements (p=0,029).
In this study, it was observed that there were changes in corneal biomechanical properties after penetrating injury repair, and these changes were related to the time elapsed after surgery and the size of injury. It should be considered that corneal biomechanical changes may affect the accurate measurement of IOP in these patients.
Ocular Surface Disease
19.02.2022 08:30
19.02.2022 10:00
15

FP91
KERATOCONUS PROGRESSION AFTER INTRASTROMAL CORNEAL RING SEGMENT IMPLANTATION IN CONFIRMED PROGRESSIVE KERATOCONUS
Vítor Miranda
Cornea
Vítor

Miranda
Portugal
To analyse how implantation of intrastromal corneal ring segment (ICRS) implantation influences progression in patients with confirmed progressive keratoconus.
Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
Retrospective study involving eyes treated with ICRS with triangular section implanted with manual technique. Visual, refractive, topographic and aberrometric measures were assessed at least four times, two of them prior to surgery to document progression (visit 1 and 2), within 6 months of surgery (V3) and after at least 2 years from surgery (V4). Progression was documented using Pentacam ® Belin ABCD Progression Display. Outcome measures included LogMAR uncorrected (UCVA) and best spectacle corrected (BCVA) visual acuity, spherical equivalent (SE), corneal dioptric power in the flattest (K1) and steepest (K2) meridians, mean corneal dioptric power (mean K), topographic astigmatism (A), asphericity at 8 mm (Q), minimum pachymetry (MP) and root mean square coma aberration (RMS-Coma).
The study evaluated 22 eyes of 20 patients with a mean age of 25.40 years ± 6.27 (SD) at implantation date (54.5% male; 45.5% male). Average follow-up duration at the last visit (V4) was 3.13 ± 0.89 years. Measurements worsened between the 2 preoperative examinations, confirming the progressive status of the disease. All visual, refractive, topographic and aberrometric measurements had a statistically significant improvement (p< 0.05) from V2 to V3 and all measurements retained significant improvement (p< 0.05) at V4 when compared to V2. At the last visit (V4) we noticed a slight regression of mean K value from 45.12 ± 2.39 (V3) to 45.80 ± 2.05 (V4; p< 0.05) and of Q value from -0.27 ± 0.21 (V3) to -0.35 ± 0.24 (V4, p< 0.05), but still markedly improved from preoperative values of 47.95 ± 2.74 mean K and -0.77 ± 0.33 Q value (p< 0.05). There were no statistically significant differences (p> 0.05) in UCVA, BCVA, SE, A and MP values when comparing V3 to V4 and there was a slight improvement in RMS-coma value from 2.684 ± 1.140 µm to 2.461±1.094 µm (p< 0.05).
ICRS implantation significantly improved visual, refractive, topographic and aberrometric parameters in confirmed progressive keratoconus. Most of these measurements remained stable at a minimum of 2 years of follow-up with exception of a slight regression in keratometry and asphericity values and an improvement in coma aberration during the follow-up period. Uncorrected and corrected visual acuity improved after surgery and remained stable throughout the follow-up period.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
1

FP92
THE EFFECTIVENESS OF INTRASTROMAL SEGMENT IMPLANTATION IN THE TREATMENT OF PROGRESSIVE KERATOCONUS OF THE INITIAL STAGES IN THE LONG-TERM FOLLOW-UP PERIOD (10 YEARS)
Artem Zakharovich Ciganov
Cornea
Artem
Zakharovich
Ciganov
Russian Federation
One of the promising methods of treatment of the initial stages of progressive keratoconus, as a manifestation of the keratectatic process, is Intrastromal corneal ring segment implantation (ICRS). The first reports of the successful implementation of this type of surgical intervention in the treatment of patients with keratoconus appeared at the end of the 20th century. Therefore, the assessment of the safety and effectiveness of the operation in the long-term observation period is certainly relevant.
To analyze the effectiveness of ICRS implantation in patients with progressive keratectasias in the long term, taking into account the use of various techniques for the formation of corneal tunnels.
Clinical studies are based on the analysis of 1185 patients (1343 eyes) with keratectasias of various origins, who underwent ICRS. Mechanical technology was performed in 1007 cases (121 cases without the use of a graduated vacuum ring (GVK), 886 – with the use of GVK), with the use of a femtosecond laser – 336 cases. Keratoconus was diagnosed in 1193 eyes, of which stage II of the disease - in 856 eyes (64%), stage III – in 487 eyes (36%). One corneal ring segment was implanted in the area of the greatest ectasia in 872 cases of asymmetric keratectasia, and two corneal ring segment were implanted in 471 cases of symmetrical keratectasia.
In all groups there was a stabilization of the keratectatic process. For 10 years, there was no progressive decrease in the thickness of the cornea and keratotopographic parameters did not change, and the ectasia zone was within the field of surgery, which indicates that ICRS has a refractive effect, and is also a method of stopping and preventing the progression of the keratectatic process.
Our 10-year experience of ICRS in the treatment of progressive keratectasias of various origins has proven high efficiency, the possibility of improving visual functions, stabilizing the ectatic process, and the safety of this type of surgical intervention.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
2

FP93
KERATOCONUS SCREENING AND TREATMENT IN A TRISOMY 21 COHORT
Barry Power
Cornea
Barry

Power
Ireland
The prevalence of keratoconus in Trisomy 21 (T21) is estimated to be up to 10 times higher than the general population. Keratoconus diagnosis is more likely to be late in Trisomy 21. Delayed diagnosis increases the likelihood of permanent vision loss or significant surgical intervention which can be very challenging for the surgeon, patient and carers. The purpose of this study was to learn more about the natural history of keratoconus in T21 and to assess whether a screening programme may be of benefit. We reviewed outcomes in a separate cohort of individuals with T21 and previously diagnosed keratoconus for comparison.
Royal Victoria Eye and Ear Hospital, Dublin, Ireland
Paediatric patients from a T21 clinic were offered an ophthalmic assessment in a tertiary referral centre. Exclusion criteria were: previous diagnosis of keratoconus, previous corneal surgery or trauma and age under 12 or over 18. Ten patients were prospectively recruited to a pilot screening programme. Data was collected on: demographics, risk factors, visual acuity, refraction, topography, interventions and outcomes. We also reviewed 11 previously confirmed cases of keratoconus in individuals with T21. Similar data was collected on this cohort.
In the screening cohort 3 were considered safe for discharge and 7 warranted further follow up. No patients required intervention after the first clinical assessment. The average age of the patients screened was 14. 8 of 10 reported a risk factor associated with keratoconus. The average KMax was 48.65 and central corneal thickness was 499.

Our previously diagnosed cohort comprised of 11 patients with an average age of 33. Seven of these patients have been crosslinked with 4 placed under regular surveillance. Nine of 11 reported a risk factor associated with keratoconus.
Keratoconus prevalence is significantly increased in T21. Eighty one percent of our patients reported at least one risk factor. Challenges with late presentation are common. Early detection and treatment with crosslinking is preferable to delayed detection and potential corneal transplantation. Although we did not confirm keratoconus in the screening cohort, some cases were suspicious. It was interesting to note the relatively steep average KMax and thin average central corneal thickness. Routine screening of individuals with T21 may help to detect KC at an earlier stage, limit visual loss and reduce the likelihood of corneal transplantation.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
3

FP94
INCREASED CHOROIDAL THICKNESS IS NOT A DISEASE PROGRESSION MARKER IN KERATOCONUS
Mário Lima Fontes
Cornea
Mário

Lima Fontes
Portugal
The recent findings of increased Choroidal Thickness (CT) in Keratoconus (KC) patients raised the question of whether CT could be an indicator of progressive KC. To test this hypothesis, we evaluated and compared the choroidal profile in progressive and non-progressive KC.
Centro Hospitalar Universitário de São João, in Porto, Portugal.
We ran a cross-sectional observational study in 76 patients diagnosed with KC, age 14–30, to assess KC progression. Progression was defined as when at least two of the studied variables confirmed progression (Kmax, Km, PachyMin, D-Index, Astig, K2, 3 mm PCR). Included patients performed a Spectralis Optical Coherence Tomography (OCT) with enhanced depth image (EDI) technology to evaluate choroidal profile. Choroidal measurements were taken subfoveally and at 500 μm intervals from the fovea, in 7 different locations, and compared between groups. Multivariate linear regression analyses were also performed to assess the influence of CT in KC progression.
Thirty-six eyes (47.4%) were classified as KC progressors. The mean subfoveal CT observed in the total sample was 382.0 (± 97.0) μm. The comparison between groups (progressive and non-progressive KC) showed no differences in the locations evaluated (mean subfoveal CT difference between groups was 2.4 μm, p = 0.915). In the multivariate analysis CT seems not be influenced by KC progression (B = 6.72 μm, 95% CI- 40.09 to 53.53, p = 0.775).
Assessment of choroidal profile does not appear to be a useful tool to differentiate progressive and non-progressive KC. Further research is needed in order to better understand the role of choroid in KC.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
4

FP95
CORNEAL COLLAGEN CROSS-LINKING IN PEDIATRIC PATIENTS – TEN-YEAR EXPERIENCE
Raquel Félix
Cornea
Raquel

Félix
Portugal
To evaluate the efficacy of corneal collagen cross-linking (CXL) in a population of pediatric patients aged 18 years or less with progressive KC, and to compare different CXL treatment protocols.
Multi-center, retrospective, cross-sectional study.
Patients with progressive KC, aged ≤ 18, who underwent CXL between 2010 and 2021 were reviewed. Different modalities of CXL were used: Standard CXL, Accelerated CXL, Combined CXL and partial topography-guided PRK (photorefractive keratectomy), and Customized CXL. Evaluation included best spectacle corrected visual acuity (BSCVA), manifest refraction, and Scheimpflug tomography evaluation. Baseline and follow-up values were compared.
The study included 44 eyes of 33 patients, 26 (78.8%) male and 7 (21.2%) female. Mean age at time of CXL was 15.2±3.1 years [range 10-18]. Conventional CXL was performed in 9 eyes, and accelerated CXL in 14 eyes. Seven eyes performed combined CXL and simultaneous topography guided PRK. Fourteen eyes performed customized irradiation CXL. Epithelium was removed before CXL in all patients. Mean follow-up was 21.9±16.6 months [range 4-66]. At the last follow-up, mean BSCVA improved from 0.43±0.26 to 0.38±0.25 LogMAR (p=0.067). Preoperative mean spherical equivalent increased from -1.97±2.44 to -2.41±3.60 D (p=0.509) and cylinder decreased from 2.85±1.92 to 2.34±1.77 D (p=0.045). The flat keratometric values (K1) remained stable, from 48.04±4.87 to 48.74±5.12 D (p=0.358), as well as the steep keratometric values (K2), from 53.63±6.60 to 53.98±6.09 D (p=0.721), and maximum keratometry values (K max), from 62.45±10.38 to 62.20±10.01 D (p=0.764). Thinnest corneal thickness decreased from 452.03±39.63 to 423.59±43.17 µm (p<0.001). Mean spherical equivalent increased in conventional CXL eyes, and had a greater decrease in those having undergone combined CXL and PRK (p=0.042). Thinnest corneal thickness decreased more significantly in the combined CXL and PRK eyes (p<0.001). No other differences between different CXL protocols were significant. Success rate at the last follow-up was 90.9%, with 4 eyes (9.1%) showing progression after CXL: 2 following accelerated CXL and 2 following customized irradiation CXL.
CXL seems to halt the progression of KC in pediatric patients and result in stabilization of visual acuity and topographic parameters. Our results are in line with the published international series for pediatric KC, showing overall good results but a higher risk of progression than adult patients. Alternative protocols seem to be equally effective as standard-CXL in pediatric KC.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
5

FP96
INDIVIDUALIZED TOPOGRAPHY-GUIDED CROSSLINKING FOR KERATOCONUS – COMPARISON OF EPI-ON IN HIGH OXYGEN TO EPI-OFF IN ROOM AIR PROTOCOLS.
Anders Behndig
Cornea
Anders

BEHNDIG
Sweden
To compare the efficacy, safety and healing phase of two different Customized Remodeled Vision (CuRV) crosslinking protocols for keratoconus.
Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden.
This ongoing study so far includes 27 patients at 12 month follow up with bilateral progressive keratoconus treated with bilateral CuRV; one eye with a high-oxygen epi-on protocol, the other eye with an epi-off protocol in room air, which was randomized and masked to the participant. Uncorrected (UDVA) and corrected visual acuities (CDVA), low-contrast visual acuities (LCVA) at 10% and 2.5%, refractive spherical equivalents (SE), keratometry readings (Kmax), endothelial cell count (ECC) and adverse events were analyzed pre- and post-treatment. The discomfort symptoms during the healing phase for each eye was registered during the first week post treatment.
UDVA improved at 12 months (-0.25 ±0.29 logMAR for epi-on; -0.18 ± 0.17 logMAR for epi-off, (p<0.01), as did the CDVA (-0.11 ± 0.13, -0.11 ± 0.12, respectively, p<0.01), the Kmax (-1.71 ± 2.16, - 1.30 ± 2.15 D, respectively, p<0.01) and 10% LCVA (-0.24 ± 0.36 and -0.15 ± 0.14, respectively, p<0.01). LCVA 2.5 % improved more in epi-on (-0.43 ± 0.93, -0.26 ± 0.66, respectively, p<0.05).The epi-on eyes had less discomfort during the first week post-treatment. A slight reduction in ECC was noted in epi-off (-175 ± 212 cells/mm2, p< 0.01). [AF1] No adverse events occurred.
So far, our results indicate that the novel high-oxygen epi-on treatment protocol may be a promising alternative to epi-off CuRV. Our upcoming 24-months results will show if this impression can be confirmed.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
6

FP97
KERATOCONUS MANAGEMENT WITH CUSTOMIZED CROSSLINKING COMBINED WITH TOPOGRAPHY-GUIDED PHOTOREFRACTIVE KERATECTOMY
Joao Quadrado Gil
Cornea
Joao

Quadrado Gil
Portugal
Corneal cross-linking (CXL) is an evolving therapy for the treatment of progressive keratoconus (KC). Conventional treatments have shown to be able to stabilize progression but its inability to improve vision is an important insufficiency. Various treatment combinations have been proposed and reported extensively to improve outcomes.Some protocols include combining a partial topography-guided surface ablation with CXL. Costumized irradiation protocols are also purported to provide greater localized flattening.We report on the outcomes of a treatment protocol combining partial topography-guided normalization and customized corneal crosslinking (CXL) for the treatment of keratoconus.
Unidade de Oftalmologia de Coimbra (UOC), Coimbra, Portugal
Prospective interventional case series. Consecutive patients with progressive keratoconus underwent a combined treatment protocol that included a 50 µm phototherapeutic keratectomy epithelial debridement followed by a topography-guided partial PRK treatment of maximum 50 µm. The corneas were then irradiated using a customized profile designed as the superposition of 3 concentric areas centered on the thinnest point. The treatment starts from a baseline broad-beam illumination including the flattest peripheral area and then is continuously masked until only the central inner circle is irradiated. Energy exposure is 5.4J/cm 2 in the outer circle and then increases centripetally to 7.5 J/cm 2 and 10 J/cm 2.
Six eyes from 6 patients, mean age 29.3±7.9 years, with an average central corneal thickness of 468.3 mm, were included. Mean CDVA improved from 0.37 at baseline to 0.15 logMAR, over a postoperatively mean follow-up of 14.00 ± 2.87 months. All patients gained 2 or more lines of vision with no patient presenting with loss of lines. Mean refractiev astigmatism improved from 3.5 D to 2.4 D, with a maximum reduction of 3.5 D observed. The maximal curvature (KMax) improved from 56.02±3.10 to 50.80±2.11 and steep keratometry reading (K2) from 49.85±1.19 to 48.77±2.27. None of the patients developed significant complications during the course of the follow-up, with reepithelialization being achieved within one week postoperatively for all patients.
This pilot study showed a significant improvement in visual acuity and refractive astigmatism, while achieving simultaneous stabilization of disease progression. A combined approach that incorporates customized cross-linking stabilization and refractive normalization with PRK can provides us with new therapeutic option in KC cases.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
7

FP98
THE EFFECT OF TOPOGRAPHY-GUIDED CORNEAL CROSSLINKING ON THE CURVATURE OF THE POSTERIOR CORNEAL SURFACE
Celso Cabral Costa
Cornea
Celso
Cabral
Costa
Portugal
Corneal crosslinking (CXL) is an evolving therapy for the treatment of progressive keratoconus (KC). Topography-guided CXL has been proposed as an alternative to standard CXL, targeting greater flattening of the cone apex and improved visual function. While structural changes in the posterior surface of the cornea commonly precede anterior irregularities, the irradiating effect of CXL is limited to the anterior half of the cornea and its effectiveness is usually assessed looking only at the anterior corneal surface. Our goal was to evaluate the stabilizing effect of CXL on the posterior corneal surface of patients treated with a topography-guided CXL protocol.
Unidade de Oftalmologia de Coimbra (UOC), Coimbra, Portugal
Prospective case series of keratoconus patients consecutively submitted to CXL using the KXL-II® platform (Avedro, Waltham, MA, USA). We designed a treatment protocol of centripetally increasing fluence from 5.4J/cm2 to 10J/cm2 centered on the thinnest corneal point as chosen on corneal tomographies (Oculus Pentacam, Optikgerate GmbH, Wetzlar, Germany). We collected data on pre- and post-treatment BCVA, anterior and posterior corneal curvature parameters. Post-treatment values were measured at 12 months after the intervention. Student's t tests were used to compare pre- and post-treatment continuous variables. AnA level of 0.05 was considered as significant.
We included 62 eyes from 52 patients, age 23.8±7.3 years. Pre- and post-treatment BCVA were 0.35±0.24 and 0.19±0.14 logMAR (p<0.001). Pre- and post-treatment anterior mean K of 4 mm zone [AR1] were 48.38±0.49 and 48.35±0.65 (p=0.49), while pre- and post-treatment posterior K were -7.20±0.14 and -7.17±0.15 (p=0.56). Pre- and post-treatment 4 mm zone anterior corneal topographic astigmatism [AR2] were 3.74±0.21 and 3.89±0.38 (p=0.36) and posterior corneal astigmatism were -0.80±0.08 and -0.80±0.06 (p=0.49). Pre- and post-treatment posterior float values were 55.62±2.08 and 57.11±3.03 (p=0.34).
Biomechanical changes caused by keratoconus induce curvature changes in both the anterior and posterior corneal surface. Despite the tailored and targeted nature of our treatment protocol, in which the inferior part of the cornea receives most of the UVA energy, it seems it can effectively stabilize both the anterior and posterior corneal surfaces, while also improving vision.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
8

FP99
OUTCOME OF CUSTOMIZED CORNEAL COLLAGEN CROSSLINKING (CURV) FOR KERATOCONUS PATIENTS IN OMAN – UP TO 3 YEARS RESULTS
Rashid Al Saidi
Cornea
Rashid

Al Saidi
Oman
To report the outcome of customized corneal collagen crosslinking for keratoconus patients in Oman over 3 years follow up period
This prospective study was planned to carry out at the Ophthalmology Center, MOD-hospital, Muscat, Oman with initial 1 year follow up period starting from 2nd September 2018 and later extended to 3 years to assess the long term outcome
Keratoconus patients in the age group of 12-30 with documented progression were included in the study. Epithelial ablation was done over the specific targeted area and corneal collagen crosslinking was carried out with application of Riboflavin followed by UVA light. The treatment area and energy levels were customized according to the topographic findings.
Continuous illumination was used with an energy fluence of 30mW/cm2. Total energy levels were ranged from 5.4J/cm2up to 10J/cm2 with the highest energy being to the center.
Clinical evaluation included uncorrected distance visual acuity(UCVA), corrected distance visual acuity(BCVA), corneal topography, pachymetry and K-reading.
Total of 54 eyes were treated. 1 year follow up data was available in 48 eyes for analysis but 3 year follow-up data was available in 20 eyes only. Hence an overall analysis of 1 year data and individual analysis of 3 year data was carried out.
At the 1 year follow up assessment of 48 eyes; 89% had improved UCVA from 1 line (LogMAR) to 6 lines or remained stable. 95% had improved BCVA from 1 line to 5 lines or remained stable. Considering the K-max 61% had shown 1 to 6 Diopter(D) flattening while 39% had progressed further but not more than 1D. Considering the Topographic Keratoconus Classification(TKC), 40% had improvement in the TKC stage while the rest remained same.
After 3 years, each of the 20 eyes were compared with their findings at 1 year follow up visit.
19 eyes (95%) had further improvement in UCVA up to 2 lines or remained stable while 1 eye (5%) showed further deterioration of 1 line. 5 eyes(25%) showed further improvement of BCVA from 1 to 3 lines. All the other 15 eyes (75%) had maintained the BCVA same as 1 year follow up visit. Considering the corneal steepness; 19 eyes(95%) showed further reduction or stability in Kmax while 1 eye (5%) showed further steepening of more than 1D. Change in the Topographical Keratoconus Classification(TKC); all 20 eyes maintained the TKC stage as same as 1 year follow up.
Epithelium-off customized corneal collagen crosslinking (Epi-Off CuRV) was safe and effective in stabilizing the progression of keratoconus by 12 months for most patients in this study group. Final results of this novel application of collagen cross-linking show that almost all patients who have completed 3 years follow up have maintained or further improved their visual function. These long term results are encouraging and data in larger studies would give us more information. Studies using Epi-Off CuRV with pulsed, higher dose UVA may further inform treatment parameter efficacy.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
9

FP100
TREATMENT OF ACANTHAMOEBA KERATITIS BY CORNEAL CROSS-LINKING
Yulduz Nizametdinova
Cornea
Yulduz

Nizametdinova
Russian Federation
To describe the outcomes of multiple high fluence accelerated PACK-CXL (photo activated chromophore for keratitis) in treating of acanthamoeba keratitis with bacterial superinfection in patient who was allergic to all topical medication.
Microsurgery department No 3, State hospital No 2, Saint Petersburg, Russia.
A healthy 31-year old female presented with a severe unilateral keratitis. The acanthamoebic and bacterial etiology of infection was detected through the use of in vivo confocal microscopy (HRT). The infection was treated by anti-amoebic, antibacterial and anti-inflammatory medications. Clinical presentation was complicated with significant allergic response to all of them. To decrease these signs and stimulate curing we reduced the amount of topical therapy and used procedures of PACK-CXL. That included two accelerated PACK-CXL (20 mW/cm2 4 min 30 sec, total fluence 5.4 J/cm2) and three accelerated high fluence PACK-CXL (30 mW/cm2 4 min, total fluence 7.2 J/cm2).
In this case of advanced acanthamoeba keratitis with bacterial superinfection five procedures of accelerated PACK-CXL led to pain relief and total epithelization of corneal defects during 5 months with minimal using of topical anti-amoebic and anti-inflammatory therapy.
High fluence accelerated PACK-CXL (30 mW/cm2 for 4 min, total fluence 7.2 J/cm2) show the most significant effects. It might be a useful method for treating acanthamoeba keratitis associated with bacterial infection.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
10

FP101
ANTERIOR CH

CASE SERIES OF MISDIRECTION SYNDROME IN ENDOTHELIAL KERATOPLASTY: AN UNUSUAL COMPLICATION.
María García Lorente
Cornea
María

García Lorente
Spain
To present a case series of Misdirection Syndrome (MS) that developed during and after Endothelial Keratoplasty (EK).
Tertiary reference centers
A retrospective, multicenter study was performed to identify patients who developed MS while undergoing Descemet membrane endothelial keratoplasty (DMEK) and Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK) from 2019 to 2020. Demographic data, preoperative history, operative notes, and postoperative course were reviewed.
We described 10 cases of MS after EK (7 eyes after DMEK and 3 eyes after DSAEK). Mean age was 71.6±12.26 years, 80% were women. Nine patients were pseudophakic; 1 patient had EK combined with phacoemulsification and intraocular lens (IOL) implantation. Average axial length was (AL) 21.61±0.86 mm and the mean intraocular lens power was 27.71±1.60 diopters. Average anterior chamber (AC) volume was 2.16±0.41 mm. All intraoperative cases required pars plana vitreous (PPV) decompression with needle or vitreous cutter. Two postoperative cases of MS were managed only with medical therapy; two required PPV combined with zonulectomy, iridectomy and capsulectomy. Resolution of MS was seen in 8 cases. Average final intraocular pressure was 18.2 ± 3.99 mmHg. Clear graft was achieved in 6 eyes (60%). Six eyes (66.66%) gained one line or more of visual acuity.
We present the largest case series of MS in EK to date. Elderly women, preoperative shallow AC, short AL and previous cataract surgery appear to be common contributing factors.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
11

FP102
OUTCOMES OF DMEK – STAGED PROCEDURE VS COMBINED: SYSTEMATIC REVIEW & META-ANALYSIS
Ritika Mukhija
Cornea
Ritika

Mukhija
United Kingdom
To compare the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in combination with, before or after cataract surgery
Systematic review and meta-analysis
All studies in English language published in peer-reviewed journals, which assessed the outcomes of DMEK in combination with (DMEK triple; group 1), before (phakic DMEK; group 2) or after cataract surgery (pseudophakic DMEK; group 3) in patients with Fuchs endothelial corneal dystrophy (FECD) were included. Studies with mixed indications were included but only results of FECD patients were collected and results of any other indication, keratoplasty or aphakic patients were excluded. Primary outcome: Mean gain in best corrected LogMAR visual acuity (BCVA). Secondary outcomes: Graft detachment, rebubbling rates, graft rejection, graft failure and endothelial cell loss.
A total of 12 studies (number of eyes, n = 1932) were included; of these five studies were exclusively for DMEK triple (n=696), one for phakic DMEK (n=286), two for pseudophakic DMEK (n=950) and remaining four compared between two of these three categories. At 6 months, there was a mean gain in logMAR BCVA of 0.34+0.04 in group 1, 0.25+0.03 in group 2, and 0.38+0.03 in group 3. When compared, the difference was significant between groups 1 & 2 (Chi2=11.47; p=0.0007) and between groups 2 & 3 (Chi2=35.53 p<0.00001); however, there was no significant difference between groups 1 & 3 (Chi2 = 2.20; p=0.14). At 12 months, there was mean gain in LogMAR BCVA of 0.52+0.05 in group 1 and 0.38+0.06 in group 3, difference being statistically significant (Chi2=14.04; p=0.0002). There were no studies reporting BCVA at 12 months in group 2. Rebubbling rate was 15% in group 1 (n=430), 4% in group 2 (n=275) and 10% in group 3 (n=883), the difference being statistically significant (p=0.001). Graft detachment rate was 31% in group 1 (n=180), 8% in group 2 (n=286) and 13% in pseudophakic DMEK group (n=696), difference again being statistically significant (p=0.001). However, there was no significant difference between DMEK triple and pseudophakic DMEK groups in terms of graft rejection, graft survival rates and endothelial cell loss at 12 months; this comparison could not be made for phakic DMEK group as the follow-up duration was only six months.
Mean gain in vision in DMEK triple group was comparable to staged pseudophakic DMEK at 6 months; however, was significantly better at 12 months. Although rebubbling rate and graft detachment rates were highest in DMEK triple compared to other groups, there was no significant difference in overall graft rejection, graft survival rates and endothelial cell loss. However, the results should be interpreted with caution due to high risk of study design bias and unequal distribution of number of eyes in each group for different outcomes.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
12

FP103
OUTCOMES OF DESCEMET MEMBRANE ENDOTHELIAL KERATOPLASTY IN EYES WITH GLAUCOMA, MACULOPATHY, AND PREVIOUS CORNEAL TRANSPLANTS.
Eleanor Ngwe Nche
Cornea
Eleanor
Ngwe
Nche
Israel
To report and analyze the outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with corneal edema and associated ocular morbidities (glaucoma, maculopathy, and eyes after corneal transplants) in comparison to eyes without without.
Ophthalmology department of the Hadassah-Hebrew University Teaching Hospital, Jerusalem, Israel.
A retrospective study of seventy-seven (77) DMEK cases was done. Eyes after combined surgeries, vitrectomy, and eyes with AC IOL were excluded. Main outcome measures were Best Corrected Distance Visual Acuity (BCDVA) and graft survival. Eyes were separated into six groups as follows and analyzed: Glaucoma Only (GO), Glaucoma and Maculopathy (GMC), Glaucoma and previous Corneal transplant (GCT), previous Corneal Transplant (CT), Maculopathy Only (MO) and No associated glaucoma, maculopathy or corneal transplant (N).
Overall, median BCDVA improved from 2.0 [0.2, 3] logMAR before surgery to 0.3 [-0.1, 2.0] logMAR 12 months after DMEK (p<0.001) with no difference between the groups at 1month, 3 months, 6 months and 12 months follow up times (p<0.05). Median BCDVA logMAR from before surgery improved significantly at 12 months in the N group; 1 [0.4, 3] to 0.2 [-0.1, 0.7] (p<0.001), CT group; 2 [0.2, 3] to 0.4 [0.1, 2] (p<0.01) and the GCT group; 2 [0.7,3] to 0.4 [0.2, 2] (p<0.05) but was not significant in the GO group; 1 [0.3, 3] to 0.3 [0.18, 2] (p>0.05), the MO group; 0.6 [0.2, 3] to 0.45 [0.1, 8] (p>0.05), and the GMC group; 1.0 [0.3,3] to 0.4 [0.1, 0.6] (p>0.05). Overall graft survival rate was 77.9% at 12 months. Highest in the N group (89.5%) and lowest in the GCS group (63.3%) (p=0.71).
DMEK offers visual rehabilitation in eyes with associated ocular morbidity. The least improvement in visual acuity is seen in patients with associated glaucoma, or maculopathy, or a combination of glaucoma and maculopathy. Eyes with glaucoma after previous corneal transplantation experience a significant improvement in vision at 12 months, but graft survival is 29% lower than in normal eyes.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
13

FP104
HIGHER ORDER ABERRATIONS AFTER DESCEMET STRIPPING ONLY IN PATIENTS WITH FUCHS DYSTROPHY
Nino Hirnschall
Cornea
Nino

Hirnschall
Austria
To quantify the change of higher order aberrations due to descemet stripping only (without using a transplant).
Sydney Eye Hospital, Sydney, Australia.
Prospective study.
This prospective study included patients with Fuchs dystrophy scheduled for surgery. In all cases corneal higher order aberrations were measured using the iTrace device (Tracey technoilogies, USA). Descemet stripping only (DSO) was performed by one experienced corneal surgeon (GM). Patients were followed up frequently until 12 months after surgery. Additionally to iTrace measurements, Pentacam HR (Oculus, Germany) measurements were taken as well as autorefraction, subjective refraction and slit lamp images.
In total 25 patients eyes of 25 patients were included in this study. Increase in best corrected visual acuity was 7 letters on the ESCRS chart (SD: 3.0 letters). There was no significant refractive shift and no significant change in higher order aberrations. Z40 (spherical aberration) increased slightly after DSO by 4.1% (SD: 2.4%). This change was not found to be significant.
There is no relevant change concerning lower or higher order aberrations. Therefore, the procedure of DSO appears to increase visual quality.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
14

FP105
CORNEAL GRAFT SURVIVAL ANALYSIS AFTER PENETRATING KERATOPLASTY IN A RETROSPECTIVE COHORT STUDY
Victoria Myasnikova
Cornea
Sergey

Sakhnov
Russian Federation

Although corneal transplantation techniques have become increasingly sophisticated, a review of publications on this topic shows that immunological rejection reactions remain relevant. The pathogenesis of graft disease is complex, associated with many risk factors related to the recipient, donor, surgical technique, and perioperative therapy. The aim of this work was to evaluate the long-term results of penetrating keratoplasty in patients of different risk groups and to identify risk factors for corneal graft disease.
Retrospective cohort study conducted at the S Fyodorov Eye Microsurgery Federal StateInstitution - Krasnodar, Russia.
Data of 582 patients after corneal transplantation performed in the period since 2011 to 2019 for keratoconus (41%), as well for corneal leucorrhoea and dystrophies (59%), aggravated by concomitant pathology - the so-called high-risk keratoplasty (HRK) were analyzed in a retrospective cohort study. We estimated the functional results and incidence of graft disease (GD). The calculation of the t-criterion; cross-tabulation method; Kaplan-Meier survival analysis and multivariate analysis were applied.
As a result of penetrating keratoplasty, the BCVA (best corrected visual acuity) in patients with keratoconus increased by 20%; in patients with HRK – by 8%. In the general group the graft survival rate was 72%, while the 8-year successful graft engraftment in patients with keratoconus comprised 91%, with HRK – 60%. A significant relationship of the GD development with preoperative diagnosis and rekeratoplasty was determined. The risk of GD incidence was minimal in patients under 30 years of age and maximum in patients aged from 50 to 70 years. Survival rates for corneal transplants were better in men than in women. Multiple regression analysis showed a significant correlation with surgical outcome of primary diagnosis, rekeratoplasty and patient age (p≤0.05).
Penetrating keratoplasty in patients with keratoconus provides a good functional result with a minimal risk of graft disease development. With penetrating keratoplasty in high-risk patients, the effectiveness of surgical interventions is significantly lower (by ~ 30%). Survival analysis showed the highest statistically significant correlation of graft disease occurrence with preoperative diagnosis and rekeratoplasty. Graft survival was significantly higher in the case of uncomplicated keratoplasty on the contralateral eye in the history.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
15

FP106
CARRYING OUT A THERAPEUTIC PLASMAPHERESIS COURSE TO PREVENT GRAFT DISEASE IN KERATOPLASTY PATIENTS: IMMUNOLOGICAL AND CLINICAL RESULTS
Tamriko Zakaraiia
Cornea
Sergey

Sakhnov
Russian Federation

Plasmapheresis is an effective method in transplantology to prevent graft rejection (kidney, heart, liver) by removing components associated with immunological processes from the blood plasma. However, the issue of the application of this method in corneal transplantation has not been practically studied and there are only theoretical ideas about its potential effectiveness. The aim of our study is to evaluate the immunological and clinical effectiveness of plasmapheresis as a method to prevent and treat graft rejection reactions in keratoplasty.

Prospective study conducted at the S Fyodorov Eye Microsurgery Federal State Institution - Krasnodar, Russia.
The study involved patients, who underwent a course of plasmapheresis and penetrating keratoplasty (main group, analyzed prospectively) and patients who underwent penetrating keratoplasty, but did not undergo plasmapheresis (comparison group, analyzed retrospectively). The control group consisted of conditionally healthy individuals of both genders. Subgroups of patients with high and low risk keratoplasty were also identified within the Main group and the Comparison group. Investigated were: the level of C-reactive protein (CRP), stimulated cytochemical index (SCI), the mobilization coefficient (MC) and the levels of the interleukins (IL1&beta;, IL6, IL17) after the course of plasmapheresis and keratoplasty.
Patients who received a course of plasmapheresis demonstrated a statistically significant decrease in the level of CRP and mean SCI and the MC. The patients showed different dynamics of the levels of the studied IL after the course of plasmapheresis depending on the risk group for keratoplasty. In patients of the Comparison group the maximum number of cases of graft disease (n = 24) was observed in the first 500 days after surgery. The patients of the Main group who underwent plasmapheresis had the best graft survival rates: during the observation period, there were no cases of graft disease.
In patients of the Comparison group who did not receive a course of plasmapheresis in the preoperative period, over a period of 1.3 years, 22 cases (24%) developed graft disease, while patients of both subgroups of the Main group who received a course of therapeutic plasmapheresis in the preoperative period, didn't demonstrate any cases of graft disease. The obtained data indicate the ability of plasmapheresis, performed in the perioperative period, to prevent the development of graft disease in patients with keratoplasty.
Keratoconus / keratoplasty
20.02.2022 08:15
20.02.2022 09:45
16

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