Aegean Retina XVII, Book of Abstracts

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aegean retina XVII

Organizing committee

Dean Eliott, USA Thomas Friberg, USA constantin pournaras, sWITZERLAND Dimitra Skondra, USA Miltiadis Tsilimbaris, GREECE Demetrios Vavvas, USA

Elounda crete Greece

Founders

Evangelos Gragoudas, USA Ioannis PalLikaris, GREECE

Secretary

Irini Kokolaki, GREECE

3-5 JUNE 2022

www.aegeanretina.com

Meeting’s Program Book of Abstracts



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Elounda Crete 3rd - 5th of June 2022

Welcome to the 17th Aegean Retina Meeting Elounda Crete 3rd – 5th of June 2022

Aegean Retina, since its inception in 1989 by Evangelos Gragoudas of the Massachusetts Eye and Ear Hospital and Ioannis Pallikaris of the University of Crete, has been a unique forum for the scientific interaction of innumerable international retinal specialists. The spectacular scenery of the Aegean region is a special allure, and over three decades devoted retina specialists have formed the “Aegean Retina Family”. This family is continuously enriched by new and repeat participants, so welcome to you all.

We expect this year's meeting, the 17th of a successful series, to be unforgettable!

The Organizing Committee. D. Eliott, T. Friberg, C. Pournaras, D. Skondra, M. Tsilimbaris, D. Vavvas

Secretary. Mrs. Irini Kokolaki


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OVERVIEW OF EACH DAY

Thursday June 2nd, 2022 16:00 - 18:00

Registration and distribution of conference material.

20:00 Welcome Cocktail at the Veghera Bar, Elounda Beach Hotel.

Friday June 3rd, 2022 08:00

Registration and distribution of conference material.

08:15 - 08:30

Welcome

08:30 - 10:00

Plenary Session Ι

10:00 - 10:30

Coffee Break

10:30 - 12:10

Plenary Session ΙΙ

Saturday June 4th, 2022 08:30 - 10:00

Plenary Session ΙΙΙ

10:00 - 10:30

Coffee Break

10:30 - 12:00

Plenary Session ΙV

Sunday June 5th, 2022 09:15 - 10:50

Plenary Session V

10:50 - 11:00

End of the meeting - Conclusions

layout and printing by: www.visionadv.gr 2810 314919

21:00 Dinner at Thalassa Restaurant, Elounda Bay Palace Hotel.


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SCIENTIFIC PROGRAM

Friday June 3rd, 2022 08:00

Registration open

08:15

Openning / Welcome

08:30

SESSION Ia (Moderator: Dr. Tsilimbaris) Stavrakakis Ia1 (CR) A case of longstanding post-traumatic endophthalmitis. How long to treat? Vartsakis Ia2 (CR) Glaucoma-associated papillomacular retinoschisis. A case report and differential diagnosis of peripapillary and macular retinoschisis. Giannopoulos Ia3 (PP) A novel sutureless scleral fixation technique for the management of aphakia. Pallikaris Ia4 (PP) Fixoflex, refilling the post-cataract empty capsule may stabilize vitreous floating.

09:00

Discussion

09:10

SESSION Ib (Moderator: Dr. Pallikaris) Chalkia Ib1 (CR) Severe hypertensive retinopathy in children: A clinical case and review of the literature. Chiou Ib2 (CR) Frizzle-Frazzled. Mataftsi Ib3 (PP) Update on ROP treatment- the scene has changed. Androudi Ib4 (PP) Scleral buckling surgery for stage 4A and 4B retinopathy of prematurity in critically ill neonates.

09:45

Discussion

10:00

Break

* For Paper Presentations (PP) are allocated 8 min * For Case Reports (CR) are allocated 5min


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Friday June 3rd, 2022 10:30

SESSION IIa (Moderator: Dr. Skondra) Seliniotaki IIa1 (CR) Retinitis pigmentosa gene variant associated with very high myopia. Iannaccone IIa2 (PP) Managing inflammatory complications in inherited retinal degenerations: beyond cystoid macular edema. Wu IIa3 (PP) Fundus Findings in Waldenstrom Macroglobulinemia and Multiple Myeloma. Munk IIa4 (PP) Machine learning to predict development of macular atrophy under anti-VEGF therapy in patients with nAMD.

11:05

Discussion

11:15

SESSION IIb (Moderator: Dr. Androudi) Ophir IIb1 (PP) Achieving Durable Dry Macula in Diffuse Diabetic Macular Edema - An Update. Hatziralli IIb2 (PP) The impact of laboratory findings and optical coherence tomography biomarkers on response to intravitreal anti-VEGF treatment in patients with retinal vein occlusion. Skondra IIb3 (PP) Repurposing Metformin for AMD: What do Big-Data and computational analysis show us so far? Plainis IIb4 (PP) Reading performance revisited using eye fixation analysis. Ktistakis IIb5 (PP) Effectiveness of anti-VEGF treatment in wet Age-related Macular Degeneration; an evaluation of reading performance with the use of eye movement analysis.

11:55

Discussion

12:10

End of 1st day * For Paper Presentations (PP) are allocated 8 min * For Case Reports (CR) are allocated 5min


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SCIENTIFIC PROGRAM

Saturday June 4th, 2022 08:30

SESSION IIIa (Moderator: Dr. Kim) Lygerou IIIa1 (PP) Anti-VEGF injection with micropulse laser for the treatment of PCV. A 12-month study. Rotsos IIIa2 (CR) All about Myopic CNV and NOT CNV. Schneider IIIa3 (CR) Bilateral ocular ischemia with ophthalmic artery steal syndrome in Takaysu arteritis: a case report and literature review. Skondra IIIa4 (PP) Gut-retina axis and AMD.

09:00

Discussion

09:10

SESSION IIIb (Moderator: Dr. Eliott) Liakopoulos IIIb1 (PP) Individualized dosimetry in Ru-106 ophthalmic brachytherapy based on MRI-derived ocular anatomical parameters. Gragoudas IIIb2 (PP) Survival after proton therapy for patients with recurrent uveal melanoma. Kim IIIb3 (PP) Long-term outcomes of prophylactic anti-VEGF treatment in patients treated with proton irradiation for choroidal melanoma. Detorakis IIIb4 (PP) Shear-wave elastographic imaging of uveal melanomas. Tatarakis IIIb5 (PP) Development of High Intensity Laser-Based Secondary Sources for Biomedical Applications using the Zeus 45TW laser at IPPL.

09:50

Discussion

10:00

Break * For Paper Presentations (PP) are allocated 8 min * For Case Reports (CR) are allocated 5min


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Saturday June 4th, 2022 10:30

SESSION IVa (Moderator: Dr. Vavvas) Giannopoulos IVa1 (CR) Management of PVR retinal detachment in a patient of severe nanophthalmos. Charonis IVa2 (CR) Non-Nanophthalmic Uveal Effusion Syndrome: A Diagnostic and Therapeutic Clinical Algorithm. Papathomas IVa3 (CR) Surgical management of PVR retinal detachment and massive choroidal detachment after trauma. Petousis IVa4 (CR) A case of optic disc maculopathy treated with pars plana vitrectomy and inner retinal fenestration. Dervenis IVa5 (PP) Intraocular tamponade choice for idiopathic macular hole surgery and the option of air: a systematic review and meta-analysis of comparative clinical trials.

11:00

Discussion

11:10

SESSION IVb (Moderator: Dr. Gragoudas) Tsoka IVb1 (PP) Novel liposomal formulation for sustained release of moxifloxacin; efficacy in experimental bacterial endophthalmitis. Missiakas IVb2 (PP) Staphylococcus aureus decolonization with monoclonal antibody neutralizing Protein A. Eliott IVb3 (PP) The effect of encapsulated cell-based delivery of ciliary neurotrophic factor (CNTF) on the progression of macular telangiectasia type 2: a phase 2 study. Zandi IVb4 (PP) Rho-kinase expression in human ocular fibrotic membranes. Vavvas IVb5 (PP) RIPK Necrotic Cell Death Pathway in Both Donor Photoreceptor and Host Immune Cells Synergize to Affect Photoreceptor Graft Survival.

11:50

Discussion

12:00

End of 2nd day * For Paper Presentations (PP) are allocated 8 min * For Case Reports (CR) are allocated 5min


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SCIENTIFIC PROGRAM

Sunday June 5th, 2022 09:15

SESSION Va (Moderator: Dr. Mataftsi) Kontadakis Va1 (PP) Central Serous Chorioretinopathy and Subthreshold Micro-pulse Laser Photocoagulation. Bontzos Va2 (PP) Five-year progression of myopic maculopathy in patients with degenerative myopia. Blazaki Va3 (PP) Evolution of macular atrophy in eyes with neovascular age-related macular degeneration treated with anti-VEGF agents compared to fellow non-neovascular eyes. Tsilimbaris Va4 (PP) Progression of macular atrophy in nAMD patients receiving long-term anti-VEGF therapy.

09:55

Discussion

10:10

SESSION Vb (Moderator: Dr. Detorakis) Ioannidi Vb1 (PP) Optical coherence tomography angiography in patients with systemic scleroderma. Papachristou Vb2 (PP) Evaluation of silicone oil effect on visual electrophysiology in patients with retinal detachment. Stavrakakis Vb3 (CR) Unpleasant surprise after uncomplicated phacoemulcification in one-eye patient. Vlachou Vb4 (PP) Peripapillary changes of Retinal Nerve Fiber Layer after a successful surgery for rhegmatogenous retinal detachment.

10:40

Discussion

10:50

Closing remarks

11:00

End of meeting * For Paper Presentations (PP) are allocated 8 min * For Case Reports (CR) are allocated 5min


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Friday, 3 JUNE Session Ia (8.30 am - 9.10 am) Ia1 (CR): A case of longstanding post-traumatic endophthalmitis-How long to treat? Stavrakakis A, Tsilimbaris M Ophthalmology Department, University Hospital of Heraklion, Heraklion, Greece Purpose: To report a case of endophthalmitis after trauma that requires longterm treatment. Material-Method: A 70 years old man was refered to our department for endophthalmitis evaluation and treatment. He had suffered from a full thickness corneal trauma, caused by a metal wire, for which he did not seek any advice as he had mild symptoms. Few days after he experienced visual decline and visited the emergency department. He was diagnosed with endophthalmitis for which he received intravitreal antibiotics and subsequently subconjunctival triamcinolone. As signs and symptoms did not improve, patient was referred to our clinic. Vitreous tap was done and patient received intravitreal antibiotics and antifungals. Despite temporary improvement, symptoms recurred few days after. Thus patient underwent vitrectomy and vitreous samples obtained again as previous ones were negative. Results: Finally, cultures were positive for fungus and specific intravitreal and per os treatment was initiated. Despite prolonged treatment with intravitreal antifungals, inflammation recurred soon after discontinuation. Currently he is on treatment with intravitreal injections of voriconazole and amphotericin twice weekly and there are still signs of disease activity. Conclusions: Fungal endophthalmitis requires sometimes prolonged treatment which should be individualized taking into account that maintenance dose may be needed in order to keep inflammation to a minimum level.


ABSTRACTS

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Friday, 3 JUNE Session Ia (8.30 am - 9.10 am) Ia2 (CR): Glaucoma-associated papillomacular retinoschisis - A case report and differential diagnosis of peripapillary and macular retinoschisis. Vartsakis G Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden Purpose: To present the clinical features and differential diagnosis of retinoschisis involving the peripapillary and papillomacular area in glaucomatous eyes, as well as to the report the clinical course of a patient with asymmetric pseudoexfoliative glaucoma. Case / Observations: A 73-year-old woman with pseudoexfoliative glaucoma and progressive visual field loss in her right eye was referred to the vitreoretinal service of our department with ipsilateral, new-onset macular retinoschisis. Review of her optical coherence tomography (OCT) scans showed peripapillary retinoschisis involving both the outer plexiform layer (OPL) and retinal nerve fiber layer (RNFL) with late macular involvement. No evidence of glaucomatous damage was present in her fellow eye, while OCT imaging showed transient peripapillary schisis with spontaneous resolution. There was no history of myopia and fundus imaging failed to demonstrate the presence of optic pit, epiretinal membrane or vitreomacular traction. Finally, she had no known family history of macular retinoschisis. Conclusions and Importance: Peripapillary retinoschisis with late macular involvement may occur in eyes with glaucomatous optic neuropathy, where intraocular pressure (IOP) fluctuations and IOP-lowering treatments may play role. In view of the numerous conditions sharing similar clinical features, occasionally indicating a surgical approach, it is proposed that a thorough clinical assessment is performed and a vitreoretinal consultation is sought.


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Friday, 3 JUNE Session Ia (8.30 am - 9.10 am) Ia3 (PP): A novel sutureless scleral fixation technique for the management of aphakia. Giannopoulos T 1st Ophthalmology Department, AHEPA University Hospital, Thessaloniki We describe a novel technique of scleral fixation of the Carlevale sutureless scleral fixation IOL. The technique does not use scleral flaps or scleral pockets and can be used in any case of aphakia, even in severe cases of ruptured globe. In our case series 38 eyes of 37 patients were implanted with an SSF singlepiece IOL and we will present our results.


ABSTRACTS

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Friday, 3 JUNE Session Ia (8.30 am - 9.10 am) Ia4 (PP): Fixoflex, refilling the post-cataract empty capsule may stabilize vitreous floating. Pallikaris I BEMMO, Laboratory of Optics and Vision, University of Crete Medical School Peripheral capsule reconstruction facilitated with the use of FixOflex ring after cataract removal. The device reconstructs and refills anatomically the space which the normal human lens occupies. In this case the vitreous body does not float forward and remains more stable. The chance to affect indirectly the postoperative sub-clinical edema will be discussed.


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Friday, 3 JUNE Session Ib (9.10 am - 10.00 am) Ib1 (CR): Severe hypertensive retinopathy in children: A clinical case and review of the literature. Chalkia A, Vlachou A, Iliaki O, Tsilimbaris M University General Hospital of Heraklion, Crete, Greece Malignant hypertension occurs rarely in children and hypertensive retinopathy in children and adolescents has been described, but its incidence appears to be rare and its presentation is usually mild. We present the case of a 16-years old girl who presented at the emergency department of the University General Hospital of Heraklion with bilateral blurry vision and a history of recurrent headaches. Her visual acuity was CF in both eyes and fundoscopy revealed severe bilateral grade IV hypertensive retinopathy with optic disc edema, retinal arteriolar narrowing, macular edema, Elschnig spots and peripheral serous retinal detachment. The patient was urgently referred to the pediatric department for further evaluation and treatment of the underlying hypertension led to improvement of hypertensive retinopathy and visual acuity.


ABSTRACTS

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Friday, 3 JUNE Session Ib (9.10 am - 10.00 am) Ib2 (CR): Frizzle-Frazzled. Chiou C1, Gaier E2 1

Massachusetts Eye and Ear Infirmary Boston Childrens Hospital

2

Introduction: Although the most likely causes of bilateral optic nerve swelling in siblings is familial idiopathic intracranial hypertension (IIH) or optic disc drusen (ODD), other less-known causes exist. Herein, I describe a case of two otherwise healthy siblings with hyperopia, optic disc drusen, and refractory papilledema thought to be secondary to IIH that were referred for a second opinion. On further examination, they were additionally noted to have vitreous cells, macular folds/thickening, and retinitis pigmentosa (RP). Genetic testing revealed a novel homozygous variant consistent with Membrane Frizzle Related Protein related ophthalmic disease. Methods: Case Report. Results: A 9-year-old female with nocturnal headaches and a 12-year-old male with hyperopia were diagnosed with optic disc elevation three years prior. B-scan ultrasounds had revealed ODD, but persistent peripapillary vascular obscuration was felt to be consistent with superimposed edema. MRI/MRV revealed empty sellas and lumbar puncture opening pressures were 21 and 24 cm H2O, respectively. Treatment with acetazolamide resulted in subjective clinical improvement but visual fields demonstrated persistent defects. They were referred for a second opinion. Examination additionally showed faint mid-peripheral atrophy and pigment deposition. Macular OCT showed inner retinal folds and/or thickening. Axial lengths ranged between 16.28 and 16.54 mm. Suspecting an alternative diagnosis, acetazolamide was discontinued. Fluorescein angiography showed no disc leakage but demonstrated early mid-peripheral hyperfluorescence. Genetic testing revealed a novel homozygous variant and predicted damaging/deleterious effects. Conclusion: MFRP is a membrane protein expressed in retinal pigment and ciliary epithelial cells with roles in Wnt signaling, emmetropization, and photoreceptor maintenance. Previously reported cases phenocopy our patients, and the diagnosis should be considered in patients with posterior microphthalmos, ODD, and RP.


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Friday, 3 JUNE Session Ib (9.10 am - 10.00 am) Ib3 (PP): Update on ROP treatment- the scene has changed. Mataftsi A, Seliniotaki A, Moutzouri S, Lithoxopoulou M, Ziakas N 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece The approval of ranibizumab as on-label treatment for retinopathy of prematurity (ROP) three years ago has opened a new chapter in the pharmacological therapy but also in the overall management of this disease. Remarkably, there is an absence of internationally accepted recommendations on the best indication for each type of treatment (anti-VEGF versus diode laser photocoagulation) and/or any combination, and most importantly no proposed schedule for post-treatment follow-up. Cost and resources available in each country often determine doctors' choices, while long-term effects of current treatments are not yet properly studied. Severe disease is relatively uncommon, which also means experience in dealing with it is even rarer. Anti-VEGF agents change the natural course of ROP, largely prolong the period of risk of recurrences, and thus it is of utmost importance to adapt management. As need for post-injection screening and potential intervention stretches far beyond the neonatal period, ophthalmologists unfamiliar with ROP will need to be alert for long-term ROP complications that they may be asked to face.


ABSTRACTS

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Friday, 3 JUNE Session Ib (9.10 am – 10.00 am) Ib4 (PP): Scleral buckling surgery for stage 4A and 4B retinopathy of prematurity in critically ill neonates. Androudi S1, Papageorgiou E1, Riri K1, Kardaras D1, Grivea I1, Mataftsi A2, Tsironi E1 1

Department of Ophthalmology, University Hospital of Larissa Department of Ophthalmology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2

Purpose: To determine the efficacy of scleral buckling in eyes with stage 4A and 4B retinopathy of prematurity (ROP). Methods: Seven eyes of five premature infants underwent scleral buckling for stage 4 ROP in zone II. Five eyes had stage 4A ROP, and two eyes had stage 4B ROP. Six eyes had previous diode laser photocoagulation, and one eye had received an intravitreal ranibizumab injection. Scleral buckling was the procedure of choice due to lack of access to specialized pediatric vitrectomy instrumentation. Average age at surgery was 3.4 months. Postoperative anatomic retinal status, visual acuity outcome and refractive error were assessed. Results: The scleral buckle was removed on average 8 months after surgery. Retinal reattachment was achieved in all seven eyes. At final follow-up one eye had macular ectopia and disc dragging, one eye had a macular traction fold and two eyes had optic disc pallor. Average myopic error after buckle removal was -7.5D. Conclusion: Scleral buckling can be performed safely and effectively in 4A and 4B stage ROP in critically ill infants, when access to specialized pediatric vitrectomy instrumentation is limited. This surgical technique may provide adequate relief of vitreoretinal traction with improved visual potential.


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Friday, 3 JUNE Session IIa, (10.30 am - 11.15 am) IIa1 (CR): Retinitis pigmentosa gene variant associated with very high myopia. Seliniotaki A1, Ververi A2, Prousali E1, Efstathiou G3, Gerou S3, Ziakas N1, Mataftsi A1 1

2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece 2 Genetic Department, Papageorgiou General Hospital, Thessaloniki, Greece 3 Analysi Biopathological Diagnostic Research Laboratories, Thessaloniki, Greece Introduction: Inherited retinopathies can initially present with high refractive error in the first decade of life, before accompanying signs or symptoms are evident. Methods: Case report and literature review. Results: A 4-year-old girl with very high myopia (S-12.00 C-4.00 x20 in the right and S-14.50 C-2.75 x160 in the left eye), visual acuity 0.3 logMAR in the right eye and 0.4 logMAR in the left eye, and left esotropia, presented with unremarkable past medical history and no family history of high refractive error or low vision. Anterior and posterior segment were unremarkable, except for peripapillary atrophy. In macular optical coherence tomography, thickness was decreased, while morphology was normal. Full-field electroretinogram revealed normal implicit time with reduced amplitude. During a 4-year followup, significant myopia progression ensued (S-17.25 C-3.00 x20 in the right and S-17.25 C-2.00 x160 in the left eye), with a corresponding increase in axial length, and an unchanged visual acuity. Whole exome sequencing revealed a heterozygous mutation c.212C>G (p.Ser71Ter) in RPGR, considered to be pathogenic. Segregation analysis precluded the variation in mother and sister. This RPGR variant has been reported in a Spanish family, including a male proband and several female carriers with retinitis pigmentosa and very high myopia. Conclusions: This is the first report of the specific termination codon variant of RPGR in a female proband. It is yet unclear if this patient will remain free of retinitis pigmentosa, representing a different phenotype for this genotype, as a result of X-inactivation or other contributing genes or epigenetic mechanisms.


ABSTRACTS

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Friday, 3 JUNE Session IIa, (10.30 am - 11.15 am) IIa2 (PP): Managing inflammatory complications in inherited retinal degenerations: beyond cystoid macular edema. Iannaccone A1, Alekseev O1, Adamus G2 1

Duke Eye Center, Duke University Department of Ophthalmology, Durham, NC (USA) Casey Eye Institute, Oregon Health & Science University, Portland, OR (USA)

2

We have reviewed the records of 418 subjects seen since 2016 at the Duke Center for Retinal Degenerations and Ophthalmic Genetic Diseases referred for suspected inherited retinal degeneration (IRD) who presented with inflammatory complications and underwent diagnostic testing for anti-retinal and antioptic nerve autoantibodies (AR-AAbs and AON-AAbs) as well as retinal immunohistochemistry (IHC). We present evidence that 127 cases (30.3%) had a molecularly confirmed IRD, whereas all other AAb-positive cases (n=261) had either a primary or a paraneoplastic form of autoimmune retinopathy and optic neuropathy. Among the AAb-positive IRD patients with inflammatory manifestations, we identified certain genetic clusters that were more prone to these autoimmune-mediated complications. In most cases, there was a dual retinal (CME) and optic nerve inflammatory component, and not uncommonly the latter was a main determinant of the visual acuity and/or field loss above and beyond the CME. We illustrate representative cases of these patients with visually meaningful, treatable inflammatory complications, in which treatment of these complications led to significant visual recovery. These recognizable, visually impactful, treatable complications can diminish the overall impact of IRDs and improve considerably the prognosis of affected patients. Seeking actively and treating these complications in IRD patients not only mitigates their visual burden and improves their visual outcomes, but also maximizes their chances to benefit from gene-specific or gene-independent treatments such as, but not limited to, gene therapy or optogenetics approaches.


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Friday, 3 JUNE Session IIa, (10.30 am - 11.15 am) Iia3 (PP): Fundus Findings in Waldenstrom Macroglobulinemia and Multiple Myeloma. Wu F, Eliott D Massachusetts Eye and Ear Infirmary, Harvard Medical School Waldenstrom macroglobulinemia (WM) and multiple myeloma (MM) are monoclonal gammopathies with a broad range of systemic manifestations. Ocular involvement is uncommon but can vary widely in its presentation and severity. WM features the production of monoclonal IgM proteins by lymphoplasmacytic lymphoma cells, while MM features the production of monoclonal IgG or IgA proteins by malignant plasma cells. Multiple mechanisms of end-organ damage are possible - arising from immunoglobulin-mediated disease including increased serum viscosity, blood alterations such as anemia, as well as direct infiltration by malignant cells. The more common retinal abnormalities are related to the hyperviscosity syndrome, and include vascular tortuosity, intraretinal hemorrhages, and retinal vein occlusion. Less common features such as serous detachments, peripheral nonperfusion, and paraneoplastic retinopathy have also been described. We identified fundus findings among patients with WM and MM seen by the Retina Service at Massachusetts Eye and Ear. Along with those phenotypes that have been previously described, unusual signs associated with monoclonal gammopathies included neovascularization of the optic disc, Purtscherlike retinopathy, and splinter hemorrhages. The varied and often nonspecific presentation of WM and MM in the fundus poses a diagnostic challenge for the retina specialist, requiring collaboration with a hematologist/oncologist. Plasmapheresis is reported to improve systemic symptoms as well as retinal vascular disease related to elevated serum viscosity. The role of systemic cancer therapy is less clear, having been shown to improve anatomic and functional outcomes in some but not all cases.


ABSTRACTS

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Friday, 3 JUNE Session IIa, (10.30 am - 11.15 am) IIa4 (PP): Machine learning to predict development of macular atrophy under anti-VEGF therapy in patients with nAMD. Munk M1, Gallardo M2, Zinkernagel M1, Sznitman R1, Wolf S1 1

Inselspital, Univ Hospital Bern AIMI, ARTORG Center, University of Bern, Bern, Switzerland

2

Purpose: To assess the potential of machine learning to predict development of macular atrophy at 2 years in patients with nAMD under anti-VEGF therapy. Methods: 320 eyes (239 patients) with nAMD treated of at least 2 years with anti-VEGF treatment and presenting no macular atrophy in any B-scan at baseline were included. Macular atrophy developer was defined if the OCT at 2 years showed more than 1 OCT B-scan with macular atrophy of >=0.75 presence probability, computed using a deep-learning biomarker detector. A Random Forest model was trained to predict at baseline the probability to develop macular atrophy at 2 years under anti-VEGF. The model uses morphological features which were automatically extracted from the OCT. A six cross-validation was used and no patient was present in both training and test sets, respectively. To better understand the outputs, SHapley Additive exPlanations (SHAP) values were employed. Results: Based on the baseline visit it was possible to predict the development of macular atrophy with a mean AUC=0.82 (+/-0.04) over the 6 folds. We observed that the presence of IRF and HF, and the thickness of the photoreceptor and RPE complex within the central subfield were the most important features for the prediction. Conclusion: Machine learning classifiers can predict development of macular atrophy in nAMD patients under regular anti-VEGF treatment. This may help to stratify risk and may assist in risk assessment.


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Friday, 3 JUNE Session IIb (11.15 am - 12.10 am) IIb1 (PP): Achieving Durable Dry Macula in Diffuse Diabetic Macular Edema - An Update. Ophir A Ophthalmology Clinic, Israel Purpose: Enduring diabetic macular edema (DME) might progressively injure foveal layers. The key aim of DME therapy is therefore to improve current VA and to achieve early, complete and durable macular drying. The enigma of DDME pathogenesis when macular traction was undetected has remained the major challenge for DME therapy. Therefore, therapies in these eyes were conducted for decades on a trial-and-error basis. Methods: This update focuses on the achievements of these two targets in DDME, Results: None of the current intravitreal anti-VEGF medications or steroids monotherapies achieves a longlasting outcome. Modified grid laser photocoagulation (mGLP) therapy has commonly failed. The discovery of two novel pathogeneses of DDME in eyes that had been earlier considered as 'non-tractional' DDME has turned out to be a game-changer in this fight for sight. These pathogeneses are, a) the overlooked extrafoveal vitreous traction in most eyes. Its detection was mainly aided by 3D spectral-domain optical coherence tomography (SD-OCT 1000,Topcon); b) the vasogenic DDME, namely, eyes in which extrafoveal vitreous traction membranes were unequivocally excluded by the 3D SD-OCT. Treatments that have been aimed towards these two DDME pathogeneses have enabled the achievement of highly efficacious and durable outcomes: a) Early-PPV in DDME treatment-naive eyes has achieved 92%-100% efficacy in complete, durable macular drying (n=7-120 eyes, 3-24 months of follow-up). b) mGLP for vasogenic DDME was found to be durably efficacious in 72% )13/18) of eyes after 4-24 months (mean, 15.9) of follow-up. The major cause of DDME recurrence was a mid-term (from month-5) emergence of incomplete PVD associated with extrafoveal traction, which was treatable surgically. PPV and mGLP are also cost-effective therapies world-wide. Conclusions: The cumulative data direct us towards adopting the key aim, i.e. to achieve early and a longlasting complete macular drying therapeutic outcome in DME.


ABSTRACTS

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Friday, 3 JUNE Session IIb (11.15 am - 12.10 am) IIb2 (PP): The impact of laboratory findings and optical coherence tomography biomarkers on response to intravitreal anti-VEGF treatment in patients with retinal vein occlusion. Hatziralli I, Kazantzis D, Machairoudia G, Kroupis C, Theodossiadis G, Theodossiadis P National and Kapodistrian University of Athens, Greece Purpose: To investigate potential laboratory and imaging biomarkers as treatment response predictors to intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in patients with retinal vein occlusion (RVO). Methods: Participants in this prospective study were 53 patients with treatment naïve macular edema secondary to RVO, treated with intravitreal anti-VEGF agents and followed-up for 12 months. At baseline, all participants underwent best-corrected visual acuity measurement, dilated fundoscopy, optical coherence tomography and fluorescein angiography (FFA), while full blood count and biochemical analysis of various parameters was also performed. At month 12, treatment response was examined and classified as “favorable” or “non-response”. Potential associations between laboratory/imaging biomarkers and treatment response were assessed. Results: Univariate analysis showed that “favorable” response at month 12 after initiation of anti-VEGF treatment was correlated with baseline central subfield thickness (CST)<464 µm (p<0.001), absence of subretinal fluid (p=0.004), absence of hyperreflective foci (HF) (p=0.004), intact ellipsoid zone (EZ) and external limiting membrane (ELM) (p<0.001 and p=0.001 respectively), absence of epiretinal membrane (ERM) (p=0.020) and absence of macular ischemia on FFA (p<0.001), while increased monocytes-tolymphocytes ratio was also associated with “favorable” treatment response (p=0.010). All other laboratory parameters did not reach statistical significance. However, at the multivariate analysis, EZ and ELM status, HF, macular ischemia and monocytes-to-lymphocytes ratio were found to be independent predictors of treatment response. Conclusions: Intact EZ and ELM, absence of HF, absence of macular ischemia and increased monocytes-tolymphocytes ratio at baseline can predict “favorable” treatment response in patients with treatment naïve macular edema secondary to RVO.


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Elounda Crete 3rd - 5th of June 2022

Friday, 3 JUNE Session IIb (11.15 am - 12.10 am) IIb3 (PP): Repurposing Metformin for AMD: What do Big-Data and computational analysis show us so far? Skondra D Department of Ophthalmology and Visual Sciences, The University of Chicago, Chicago, Illinois Purpose: The FDA-approved common antidiabetic drug metformin has been shown to have protective properties in multiple age-associated diseases and may have the potential to be protective for age-related macular degeneration (AMD). Purpose of this study was to investigate the relationship of metformin with AMD using Big-Data and computational analysis. Methods: Retrospective case-control study using large US health insurance claims database of 312,404 subjects with newly diagnosed AMD from January 2008 to December 2017 and 312,376 matched controls. Multivariate/adjusted regression models were used to identify risk of developing AMD and interactions among metformin and other commonly prescribed medications as insulin, sulfonylureas, glitazone, statins. For the computational analysis, we queried National Center for Biotechnology Information (NCBI) to identify AMD-associated genes to date and the resulting lists were manually curated. Enrichment analysis to predict compounds that can influence the above-identified genes was done via the ToppGene platform. This analysis estimates the statistical significance of overrepresented compounds from multiple drug-gene interaction databases to construct a Pharmacome with FDR adjusted p value <0.05. Results: Metformin use was associated with reduced odds of developing AMD (odds ratio [OR], 0.94 [95%CI, 0.92-0.96]), with low to moderate doses of metformin showing the greatest potential benefit (1-270 g/2yr, OR, 0.91 [95%CI, 0.88-0.94]; 271-600 g/2, OR, 0.90 [95%CI, 0.87-0.93]). Doses > 1080 g /2 years did not have reduced odds of developing AMD. Both the reduction in OR and the dose-dependent response were preserved in diabetic patients only cohort. Regarding interactions among medications, only subjects taking sulfonylureas with metformin demonstrated a further decreased risk compared to those on metformin alone (OR 0.94 [CI 0.91-0.97]). Metformin was associated with a decreased OR of AMD in diabetic patients without coexisting diabetic retinopathy (DR) (OR, 0.93 [95%CI, 0.91-0.95]) but not in the presence of DR (OR, 1.07 [95%CI, 1.01-1.15]). In the computational drug-gene enrichment analysis among thousands of compounds, metformin was identified as the drug with the strongest association with wet AMD genes and was among the top candidates in all dry AMD subtypes (P<0.0001 in all). Conclusions: These data suggest that metformin may be a novel AMD therapeutic strategy and provide the basis for future studies.


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Friday, 3 JUNE Session IIb (11.15 am - 12.10 am) IIb4 (PP): Reading performance revisited using eye fixation analysis. Sotiris Plainis, MSc, PhD, FBCLA Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Greece Reading is of fundamental importance in modern culture and it forms a strong predictor of vision-related quality of life, since many activities of daily living rely on its function. Thus, it is not surprising that reading difficulty is the most common complaint among individuals with decreased vision, especially patients with maculopathies. However, reading performance tests are not routinely used in clinical practice, which relies mainly on visual acuity (VA) measures, despite being a relatively poor predictor of functional vision impairment. This is because the plethora of reading tests that have been developed exhibit significant test-retest and interindividual variability, as a result of the high influence of cognitive factors, such as reading skill and personality characteristics and reader's age. The objective of this work is to present a new method based on eye movement analysis which can improve reading speed variability in silent passage reading when using standardized texts.


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Elounda Crete 3rd - 5th of June 2022

Friday, 3 JUNE Session IIb (11.15 am - 12.10 am)

IIb5 (PP): Effectiveness of anti-VEGF treatment in wet Age-related Macular Degeneration; an evaluation of reading performance with the use of eye movement analysis. Plainis S, Ktistakis E1, Simos P3, Tsilimbaris MK1,2 1

Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Greece Ophthalmology Department, University Hospital of Heraklion, Greece 3 Institute of Computer Science, Foundation of Research and Technology-Hellas, Heraklion, Greece 2

Purpose: Reading difficulty is the most common complaint among individuals with visual deficits, especially for patients with central retinal scotomas. Here, we evaluate reading performance by means of eye fixation analysis, before and after anti-VEGF treatment in wet AMD (wAMD) patients. Μethods: A group of 16 naive and relapsed wAMD patients (age range: 52-80 years), who underwent antiVEGF treatment in one eye, participated in the study. They were all examined, monocularly and binocularly, at baseline and after 3-4 months following their first visit. Central Retinal Thickness (CRT) at 1 mm area and near logMAR visual acuity (VA) were assessed. Reading performance was evaluated binocularly and monocularly using short passages of about 140 words each (0.4 logMAR print size at 40 cm distance). Eye fixation was recorded with an infrared eyetracker (Eye-Link II, SR Research Ltd). Data analysis included computation of reading speed, fixation duration, the number of fixations, and percentage of regressions. Results: Following treatment, a significant reduction (41±47 µm) in CRT was found. Although the change in CRT following treatment correlated well with the change in VA (r=-0.71), the corresponding improvement in monocular VA was minimal and not statistically significant. Monocular, silent reading speed in the treated eye also correlated well with changes in CRT (r=-0.68) and improved significantly by an average of 15.9±28.5 wpm (95% CI from 0.7 to 31.1, p=0.041). This improvement was accompanied by an average reduction of 0.24±0.38 fixations per word (95% CI from 0.04 to 0.45, p=0.023). Other eye fixation parameters did not change significantly following treatment. Conclusion: VA tests may underestimate the improvement in functional vision after anti-VEGF treatment. Evaluating reading performance and eye fixation parameters may better characterize physiological changes and the effectiveness of therapeutic approaches in wAMD patients. The study was supported by an investigator-initiated research grant by Novartis AG (CRFB002A2402T).


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Saturday, 4 JUNE Session IIIa (8.30 am - 9.10 am) IIIa1 (PP): Anti-VEGF injection with micropulse laser for the treatment of PCV. A 12-month study. Lygerou M, Kontadakis G, Karageorgiou G, Datseris I, Petrou P, Datseris I OMMA Ophthalmological Institute of Athens Introduction: The purpose of this study is the presentation of the 12-month effect of anti-vascular endothelial growth factor (VEGF) intravitreal injection combined with Micropulse laser treatment in patients with symptomatic macular polypoidal choroidal vasculopathy (PCV). Methods: This is a 12-month case series study. 20 cases were administered Micropulse laser followed by 0.5 mg ranibizumab (Lucentis) one hour later. Results: The efficacy of the method was evaluated based on the impact on visual acuity and central retinal thickness (CRT). Regarding best corrected visual acuity (BCVA), there was a statistically significant improvement by 4.6 letters, P<0.0002. Regarding the baseline CRT, there was a decrease from 485.28 µm ± 39.6 to 347.48 ± 28.0, P<0.00002 at one year follow up. Discussion: Anti-VEGF intravitreal injection combined with Micropulse laser led to statistically significant improvement of the visual acuity in the study. The CRT was significantly reduced at one year follow up. No adverse effects were noticed with regards to the treatment. It needs to be further assessed whether this treatment option should be considered for the management of PCV.


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Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IIIa (8.30 am - 9.10 am) IIIa2 (CR): All about Myopic CNV and NOT CNV. Rotsos T A University Eye Clinic of Athens We present a typical case of myopic CNV and how to treat this condition. With clinical examples, we present several other cases that may be misdiagnosed as myopic CNV and we highlight the details to avoid any pitfalls in the interpretation of imaging. By the end of the presentation the audience will have information about the whole spectrum of myopic CNV and conditions that are included in the differential diagnosis.


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Saturday, 4 JUNE Session IIIa (8.30 am - 9.10 am) IIIa3 (CR): Bilateral ocular ischemia with ophthalmic artery steal syndrome in Takaysu arteritis: a case report and literature review. Schneider A, Levy M, Abrams J Sarasota Retina Institute A 57 year old white female was referred for an abnormal right pupil associated with migraine headaches. Initially diagnosed as an Adie's pupil, she was observed and her migraines were treated with oral medications. Her headaches persisted. She returned with vision loss. A fluorescein angiogram revealed diffuse peri-ateriolar leakage in both eyes consistent with retinal vasculitis primarily affecting arterioles. She was treated with high dose IV steroids; however a work up for inflammatory and ischemic causes, including CT angiography of the head and neck, was negative. Rheumatology referral revealed peripheral bruits and weak peripheral pulses which prompted evaluation with vascular surgery. Further work up revealed severe large vessel atherosclerotic disease, previously undiagnosed due to an error in radiologist interpretation of a CT angiogram. Intracranial doppler revealed right reversal of ophthalmic artery flow and reduced flow velocity of the left ophthalmic artery. Clinical diagnosis of Takayasu arteritis with secondary severe ocular and cerebral ischemia was made. She is undergoing steroid treatment and revascularization is planned with vascular surgery.


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Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IIIa (8.30 am - 9.10 am) IIIa4 (PP): Gut-retina axis and AMD. Skondra D Department of Ophthalmology and Visual Sciences, The University of Chicago, Chicago, Illinois The gut microbiome consists of a wide collection of archaea, eukaryotes, viruses, and bacteria that play significant roles in human health and disease. Housed primarily in the gastrointestinal tract and strongly shaped by environmental lifestyle factors such as urban / industrial location, diet and medications, these commensal microorganisms are directly involved in a number of physiological functions including nutrition, host immunity, drug metabolism, and endocrine signaling1. Yet, despite its overwhelming presence, our understanding of its dynamic interactions, particularly in diseased states, has only recently begun to grow. The acceleration of next-generation analysis techniques has revealed direct connections between the microbiome and various disease pathologies. Gut dysbiosis - improper microbiota composition and function - has been linked with neurological, cardiovascular, respiratory, and metabolic diseases among others. These axes extend to the eye as well. A growing body of evidence has connected the microbiome with various retinal diseases, including age-related macular degeneration (AMD). Agerelated macular degeneration (AMD), the leading cause of blindness in older adults, is a progressive neurodegenerative disease with both exudative and non-exudative subtypes. It is known that the disease is dependent on a number of risk factors including age, genetic susceptibility, and environmental influences such as diet and smoking. These components subsequently drive the pathophysiology of the disease through inflammation, oxidative stress, and aberrant neovascularization. Although integrating these heterogeneous risk factors and mechanisms remains challenging, recent human and animal model studies suggest that the gut microbiome plays a key role in reconciling the impact of these components. In this presentation, we explore the current knowledge surrounding the gut microbiota's role in AMD creating an opportunity for better understanding of diseases mechanisms and potentially more targeted yet accessible preventive and therapeutic interventions .


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Saturday, 4 JUNE Session IIIb (9.10 am - 10.00 am) IIIb1 (PP): Individualized dosimetry in Ru-106 ophthalmic brachytherapy based on MRI-derived ocular anatomical parameters. Liakopoulos D1, Perisinakis K2, Solomou,G2, Kouvidakis A3, Drakonaki E4, Bontzos G5, Papadaki E6, Detorakis E1 1

Department of Ophthalmology, Medical School, University of Crete, Heraklion, Crete, Greece Department of Medical Physics, University of Crete, Medical School, Heraklion, Crete, Greece 3 School of Mathematics, University of Crete, Heraklion, Greece 4 Independent Radiology Practice, Heraklion, Crete, Greece 5 Department of Ophthalmology, Red Cross Hospital, Athens, Greece 6 Department of Radiology, University Hospital of Heraklion, Crete, Greece 2

Purpose: To estimate ocular geometry-related inaccuracies of the dosimetric plan in Ru-106 ophthalmic brachytherapy. Methods and Materials: Thirty patients with intraocular lesions were treated with brachytherapy using a Ru-106 plaque-shell of inner radius of 12 mm. Magnetic resonance imaging was employed to determine the external scleral radius at tumor site and the tumor margins. A mathematical model was developed to determine the distance between the external sclera and the internal surface of the plaque associated with the tangential application of the plaque on the treated eye. Differences in delivered dose to the tumor apex, sclera and tumor margins as derived by considering the default eye-globe of standard size (external sclera radius = 12 mm) against the individual-specific eye globe were determined. Results: The radius of external sclera at the tumor site was found to range between 10.90 and 13.05 mm for the patient cohort studied. When the patient specific eye-globe/tumor geometry is not taken into account, the delivered dose was found to be overestimated by 8.1%±4.1% (max=15.3%) at tumor apex, by 1.5%±2.8% (max=5.7%) at anterior tumor margin, by 16.6%±7.5% (max=36.4%) at posterior tumor margin and 8.1%±3.8% (max=13.2%) at central sclera of eyes with lower than the default radius. The corresponding dose overestimations for eyes with higher than the default radius were13.5%±4.3% (max=22.3%), 1.5%±2.8% (max=5.7%), 12.6%±4.5% (max=20.0%) and 15.1%±5.0% (max=24.4%). Conclusions: The proposed patient-specific approach for Ru-106 brachytherapy treatment planning may improve dosimetric accuracy. Individualized treatment planning dosimetry may prevent undertreatment of intraocular tumors especially for highly myopic or hyperopic eyes.


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Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IIIb (9.10 am - 10.00 am) IIIb2 (PP): Survival after proton therapy for patients with recurrent uveal melanoma. Gragoudas E, Kim I, Lane AM Mass Eye and Ear Infirmary, Harvard Medical School Purpose: An increased risk of dying from metastasis is associated with tumor recurrence in patients with uveal melanoma. The goal of the study was to quantify this risk in patients with tumor recurrences who were re-treated with proton irradiation. Risk quantification will allow ocular oncologists to provide important information to patients regarding prognosis. Materials and Methods: Patients treated with proton therapy for uveal melanoma at our institution from 1982 through 2017 were identified. Rates of melanoma-related mortality were compared between patients who experienced recurrences and those who did not. Results: Of 4283 patients treated, 154 (3.6%) were treated for local recurrence. Initial treatment was plaque radiotherapy in 24 patients and proton therapy in 130 patients. Median LBD was 13 mm and 15 mm for the recurrence-free (n=4129) and recurrence group respectively (P<.001). There were similar differences in thickness (4 mm v 5 mm, P=.0004). Growth occurred in 7.2% of tumors involving the ciliary body compared to 2.3% of choroidal tumors (P<.001). Median time to recurrence was 2.6 years overall. In patients with smaller posteriorly located tumors the 10-year melanoma-related mortality rate was 27.7% for those with recurrences compared to 12.1% in those without recurrences. A similar difference was observed when patients with large tumors involving the ciliary body were compared (67.3% v. 51.9% for recurrence and recurrence-free patients respectively). Conclusions: Tumor recurrence is associated with an increase in probability of dying from melanoma. A 15% difference in 10-year melanoma-related mortality is observed when comparing patients in different risk groups.


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Saturday, 4 JUNE Session IIIb (9.10 am - 10.00 am) IIIb3 (PP): Long-term outcomes of prophylactic anti-VEGF treatment in patients treated with proton irradiation for choroidal melanoma. Kim I, Oxenreiter M, Hashmi M, Gragoudas E, Lane AM Massachusetts Eye and Ear Infirmary, Harvard Medical School Purpose: After a pilot study suggested a visual benefit of prophylactic ranibizumab after proton irradiation for patients with small-medium choroidal melanomas located near the disc or fovea, such patients treated at the Massachusetts Eye and Ear have been offered prophylactic anti-VEGF treatment as part of routine clinical care. This study investigated visual outcomes of this larger cohort of patients receiving anti-VEGF treatment to prevent radiation retinopathy. Methods: A retrospective review identified patients with choroidal melanoma receiving anti-VEGF injections from 2016 - 2021. Only patients receiving treatment in a prophylactic manner (first injection within 6 months of radiation) were included. Baseline tumor characteristics, number of injections, visual acuity at baseline and last follow-up, as well as time from last injection to last follow-up were assessed. Results: 42 patients with median follow-up time of 6 years were included. Baseline tumor characteristics of this cohort included median largest basal diameter of 11 mm, median height of 2.9 mm, median tumor distance of 1 disc diameter (DD) from the optic disc and 0.75 DD from the fovea. The median number of injections was 12. Cumulative rates of vision retention of 20/40 or better were 35.1% at 3 years and 15.3% at 5 years. Rates of vision retention of 20/200 or better were 79.0% at 3 years and 65.1% at 5 years. The proportion of patients with visual acuity of 20/200 or better at last follow-up was greater in those patients who had received greater than 12 injections (72.2%) versus those who had less than 12 injections (55.6%). Conclusion: Even with prophylactic anti-VEGF treatment, there is significant vision loss over time in patients treated with proton irradiation for choroidal melanomas near the disc and fovea. However, there may be higher potential for vision retention with sustained injections.


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Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IIIb (9.10 am - 10.00 am) IIIb4 (PP): Shear-wave elastographic imaging of uveal melanomas. Detorakis E1, Douglas K1, Douglas V1, Liakopoulos D1, Drakonaki E2 1

Department of Ophthalmology, University of Crete Department of Anatomy, University of Crete

2

Introduction: Previous studies have assessed the potential role of strain ultrasound elastography in the imaging of uveal melanomas. This study evaluates the role of shear wave elastography in the evaluations of intraocular malignancies. Methods: Twelve patients with uveal melanomas who underwent Ru-106 brachytherapy were prospectively recruited from the Department of Ophthalmology of the University Hospital of Heraklion, in Crete, Greece. All patients underwent multi-modality ophthalmic imaging, including MRI (pre-treatment), conventional A- and B-mode ultasonography, hemodynamic imaging with triplex ultrasonography and both strain and shear-wave elastographic imaging (SWEI). All ultrasonographic studies were performed both pre-and at pre-determined post-brachytherapy intervals. Changes were examined between different imaging modalities. Results: Changes in tumor rigidity scores, derived by SWEI, were in agreement with changes in conventional ultrasonographic tumor imaging. Conclusions: SWEI may prove a valid quantitative tool in the risk assessment and post-treatment follow-up of uveal melanomas and may be used as a new metric in the management of intra-ocular tumors.


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Saturday, 4 JUNE Session IIIb (9.10 am - 10.00 am) IIIb 5 (PP): Development of High Intensity Laser-Based Secondary Sources for Biomedical Applications using the Zeus 45TW laser at IPPL. Grigoriadis A1,2, Andrianaki G1,3, Tazes T1, Petrakis S1, Skoulakis A1, Orphanos I1, Tsiapa I6, Kaselouris E1, Fitilis I1, Detorakis E5,6, Maris T6, Clark E1, Bakarezos E1, Benis E1,2, Dimitriou V1, Papadogiannis N1 and Tatarakis M1 1

Institute of Plasma Physics and Lasers, Hellenic Mediterranean University Research Centre, Rethymno, Greece, 2 Department of Physics, University of Ioannina, Ioannina, Greece, 3 School of Production Engineering and Management, Technical University of Crete, Chania, Greece 4 Department of Medical Physics, School of Medicine, University of Crete, Heraklion, Greece, 5 Department of Ophthalmology, University Hospital of Heraklion, Heraklion, Greece, 6 School of Medicine, University of Crete, Heraklion, Greece, High-intensity laser-generated electron, ion as well as photon secondary sources have attracted widespread interest during the last two decades because of the important applications, among others in biomedicine. In the field of biomedical applications in particular, laser-driven particle beams as well as laserdriven X-ray sources are a promising field of study.The recent installation of the ZEUS 45 TW laser system developed at IPPL offers unique opportunities for research in laser-driven particle and X-ray sources. Information about the facility and the experiments performed for establishing the baseline platforms for secondary plasma sources will be shared. In addition, recent experiments on gels as well as cells will be presented.


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Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IVa (10.30 am - 11.10 am) IVa1 (CR): Management of PVR retinal detachment in a patient of severe nanophthalmos. Giannopoulos T 1st Ophthalmology Department, AHEPA University Hospital, Thessaloniki We present a case of PVR retinal detachment in a 40-year-old patient with severe nanopthalmos (Axial length 14.5 mm).


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Saturday, 4 JUNE Session IVa (10.30 am - 11.10 am) IVa2 (CR): Non-Nanophthalmic Uveal Effusion Syndrome: A Diagnostic and Therapeutic Clinical Algorithm. Charonis A Retina and Uveitis Service, Athens Vision Eye Institute, Athens, Greece Purpose: To present a practical clinical approach to uveal effusion syndrome. Methods: Case report and review of the pertinent literature. Results: A 70 years-old hyperope male presented with a unilateral annular ciliochoroidal and an inferior exudative retinal detachment. He underwent a comprehensive workup, including echography and multimodal panoramic imaging in an attempt to exclude atypical central serous chorioretinopathy, annular melanoma, infiltrative choroidopathy and/or an underlying inflammatory etiology. Scleral windows in all 4 quadrants with choroidal cut-down in 2 were performed with a satisfactory outcome. Within the context of a non-nanophthalmic eye, emphasis is given on the construction of the differential diagnosis, as well as on the selection of the most appropriate variation within a plethora of surgical techniques. Conclusions: Non-nanophthalmic uveal effusion remains a diagnostic and therapeutic challenge that merits adequate understanding of its basic pathophysiology. In the ever-expanding spectrum of choroidal venous insufficiency/atypical CSCR one needs first to incorporate multimodal imaging in order to exclude such an atypical exudative phenotype. Subsequently, depending on the individual phenotype of effusion, one needs to select between multiple variations of a main surgical theme.


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Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IVa (10.30 am - 11.10 am) IVa3 (CR): Surgical management of PVR retinal detachment and massive choroidal detachment after trauma. Papathomas T 1st Ophthalmology department of Aristotle University, AHEPA Hospital, Thessaloniki ORASI One Day Unit, Trikala Video presentation of the surgical management of a patient presented with PVR retinal detachment and massive choroidal detachment (“kissing” choroidals). The patient was referred to us after having a previous open globe injury and a primary repair in a general hospital. Fundoscopy was not possible due to vitreous haemorrhage and the B-scan showed choroidal detachment (“kissing” choroidals). During the operation retinal detachment and anterior PVR was revealed.Post-operative best corrected vision acuity was 2/10 on a Snellen chart.


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Saturday, 4 JUNE Session IVa (10.30 am – 11.10 am) Iva4 (CR): A case of optic disc maculopathy treated with pars plana vitrectomy and inner retinal fenestration. Vasileios Petousis1,2, Janny Mersch1, Marie Leonhard1,2, Michelle Berna-Thill1,2 1

Ophthalmology Department, Robert Schumann Hospital, Luxembourg Centre Ophtalmologigue Val Sainte Croix, Luxembourg

2

Aim: We report on a case of optic disc pit maculopathy treated with pars plana vitrectomy (ppv)and an inner retinal fenestration (IRF). Materials and methods: This is a case of an 39 year old male with unilateral optic disc pit maculopathy, unusually presenting with not only intra/subretinal fluid but also with multiple areas of pigment epithelium detachment. The progressive accumulation of fluid was treated initially with the intravitreal injection of SF6 (100%), followed my 25g ppv, inner retinal fenestration and C2F6 (16%). Results: In spite of an apparent failure of treatment at 2 months postoperatively, there was a significant reduction of intra/subretinal fluid noted at 3 months after surgery. Conclusion: Inner retinal fenestration is a relatively new treatment for optic disc maculopathy. In our case it remains unclear if the documented improvement, well after the dissipation of the gas tamponade, ensued due to the performed fenestration or as a spontaneous development.


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Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IVa (10.30 am - 11.10 am) IVa5 (PP): Intraocular tamponade choice for idiopathic macular hole surgery and the option of air: a systematic review and meta-analysis of comparative clinical trials. Dervenis N. Α' University Ophthalmological Clinic, AHEPA, Thessaloniki, Greece Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK Purpose: To summarise the effects of different tamponade agents on the outcomes of vitrectomy for the treatment of idiopathic macular holes. Also to describe our experience with the use of air as a tamponading agent. Setting/Venue St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK Sunderland Eye Infirmary, Sunderland, UK Methods: Systematic review and meta-analysis. Randomised control trials (RCT), prospective and retrospective comparative cohort studies of patients undergoing vitrectomy, ILM peeling and any type of tamponade agent (including air, any gas or silicone oil) for full thickness macular holes were included. Main outcome measures were: primary anatomical closure; visual acuity and change from baseline postoperatively; frequency of adverse events. Results: Fourteen studies were included in the meta-analysis. Statistically significant better anatomical closure was observed when using SF6 versus C2F6/C3F8 [OR=0.49, 95% CI = (0.30, 0.79)] in patients without postoperative posturing. No difference in anatomical closure was observed in patients who were advised posturing. Regarding visual outcomes and adverse events, there was no statistically significant difference. Both the comparisons of anatomical closure of patients treated with gas tamponade versus silicone oil and air versus SF6 did not provide statistically significant results. Conclusions: We could not confirm any advantage of longer acting tamponades over SF6 regarding hole closure and vision outcomes. Air may be a suitable option for specific macular hole patients. Further properly designed research could provide more evidence about the appropriate tamponade selection.


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Saturday, 4 JUNE Session IVb (11.10 am - 12.00 n) IVb 1(PP): Novel liposomal formulation for sustained release of moxifloxacin; efficacy in experimental bacterial endophthalmitis. Tsoka P1, Scoulica E2, Magkafouraki E2, Natsaridis E3,4, Steirou T1, Antimisiaris S3,4, Tsilimbaris M1 1

Laboratory of Vision and Optics, University of Crete Medical School, Heraklion, Crete, Greece Laboratory of Clinical Microbiology and Molecular Microbiology, University of Crete Medical School, Heraklion, Crete, Greece 3 Laboratory of Pharmaceutical Technology, Department of Pharmacy, University of Patras, Rio, Greece; 4 Foundation for Research and Technology Hellas, Institute of Chemical Engineering Sciences (FORTH/ICEHT), Rio, Greece 2

Purpose: Bacterial endophthalmitis can lead to significant vision loss even after prompt and proper treatment, partially due to the limited time of antibiotics' residence in the vitreous cavity. The purpose of this study was to evaluate the efficacy of a novel drug formulation, which is specifically designed for sustained intraocular release of moxifloxacin, in an experimental model of Escherichia coli (E. coli) - induced endophthalmitis. Methods: Experimental endophthalmitis was induced in both male and female Sprague-Dawley rats. Animals received an intravitreal injection of approximately 10.000 colony - forming units (cfus)/eye of the E.coli strain U13, which is susceptible to moxifloxacin. Six hours later, animals received a second intravitreal injection with either free or liposomal moxifloxacin (conventional vs. sustained release delivery, respectively). A recently developed novel liposomal formulation of moxifloxacin was used. Clinical scores were evaluated in vivo with slit lamp biomicroscopy and direct ophthalmoscopy and animals were euthanized at 30 hours post treatment, eyes were enucleated and proceeded either for histology or for the assessment of the bacterial growth rate. Results: An inoculum of 10.000 cfus/eye of E. coli U13 resulted in conjunctival hyperemia, purulent exudations, iritis and miosed pupils (posterior synechiae) at 30 hours with mild to moderate inflammatory scores and an average bacterial load of 105 cfus/eye. A pharmaceutical intervention with either free or liposomal moxifloxacin within the 6-hours timeframe was highly effective. An intravitreal injection of liposomal moxifloxacin (1,6 µg/µl) 6 hours after the bacterial inoculation, resulted in significant reduction of the bacterial load at 30 hours to an average of 200 cfus/eye. Furthermore, animals showed resolved signs of inflammation or lack of progression of clinical signs as well as reduced infiltration. Conclusions: E. coli - induced endophthalmitis can be achieved in rats and is a highly reproducible model of experimental gram-negative bacterial endophthalmitis. Low inocula of E. coli strain U13 result in mild to moderate progress of the inflammatory signs, thus allowing pharmaceutical intervention. Liposomal moxifloxacin seems as effective as the free antibiotic at early time points. Further experimentation is currently ongoing in order to evaluate the efficacy of the novel moxifloxacin over a longer time frame.


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Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IVb (11.10 am – 12.00 n) Ivb2 (PP): Staphylococcus aureus decolonization with monoclonal antibody neutralizing Protein A. Missiakas D Department of Ophthalmology and Visual Sciences, The University of Chicago, Chicago, Illinois Clinical manifestations of Staphylococcus aureus range from asymptomatic colonization of the nasal mucosa to mild skin and soft tissue infections (SSTI) to uncontrolled invasive disease with high mortality. One third of the human population is persistently colonized with S. aureus and colonization is the key risk factor for S. aureus invasive diseases. Of particular concern are patients with recurrent SSTI or bacteremia, which occurs in 20% or more of individuals receiving surgical and antibiotic therapy. Virtually all humans develop antibodies against some of the molecular determinants of S. aureus at some time during childhood, however these immune responses do not affect colonization or protect against invasive disease. 4 out of 5 cases of recurrent infections are caused by the same strain underscoring the inability of patients to establish protective immunity. Current strategies for S. aureus decolonization include topical and systemic administration of antibiotics, which is associated with selection for antibiotic resistance and posttreatment recolonization. Using a mouse model for S. aureus colonization, we show that systemic administration of a recombinant monoclonal antibody neutralizing staphylococcal protein A (SpA) can stimulate antibacterial immunoglobulin G and immunoglobulin A responses and promote S. aureus decolonization. These results suggest that antibody neutralizing SpA, a B-cell superantigen, may also be useful for S. aureus decolonization in humans.


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Saturday, 4 JUNE Session IVb (11.10 am - 12.00 n) Ivb3 (PP): The effect of encapsulated cell-based delivery of ciliary neurotrophic factor (CNTF) on the progression of macular telangiectasia type 2: a phase 2 study. Eliott D Mass. Eye & Ear Infirmary, Harvard Medical School Purpose: To test the effects of an encapsulated cell-based delivery of a neuroprotective agent, ciliary neurotrophic factor (CNTF), on progression of macular telangiectasia type 2. Design: Randomized, sham-controlled, phase 2 clinical trial. Participants: 99 eyes of 67 patients were enrolled. Methods: Single-masked, randomized clinical trial of 24 months' duration in 11 centers. Participants were ran- domized 1:1 to surgical implantation of intravitreal sustained delivery of human CNTF versus a sham procedure. Main Outcome Measures: The primary outcome was the difference in the area of neurodegeneration as measured in the area of the ellipsoid zone disruption (or photoreceptor loss) measured on spectral-domain (SD) OCT images at 24 months. Secondary outcomes included visual function changes. Results: The eyes receiving sham treatment had 31% greater progression of neurodegeneration than the CNTF-treated eyes. Retinal sensitivity changes, measured using microperimetry, were correlated highly with the changes in the area of photoreceptor loss. The mean retinal sensitivity loss of the sham group was 45% greater than that of the treated group. Reading speed deteriorated in the sham group (-13.9 words per minute) with no loss in the treated group. Serious adverse ocular events occurred in 2 of 51 persons (4%) in the sham group and 2 of 48 persons (4%) in the treated group. Conclusions: In participants with macular telangiectasia type 2, a surgical implant that released CNTF into the vitreous cavity, compared with a sham procedure, slowed the progression of retinal degeneration. A phase 3 clinical trial is currently ongoing.


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aegean retina xvii

Elounda Crete 3rd - 5th of June 2022

Saturday, 4 JUNE Session IVb (11.10 am - 12.00 n) Ivb4 (PP): Rho-kinase expression in human ocular fibrotic membranes Souska Zandi S, Li Y, Jahnke L, Enzmann V, Zinkernagel M Inselspital, University Hospital Bern, Switzerland Purpose: Proliferative vitreoretinopathy (PVR) is the most common cause of failure after retinal reattachment surgery due to secondary growth and contraction of cellular membranes within the hyaloid and retina. The treatment of choice is either surveillance when no retinal detachment has yet occurred or vitreoretinal surgery and removal of the PVR membranes to prevent or treat further complications. Identification of factors that may interfere with the formation and regulation of PVR membranes could facilitate the development of novel therapeutics. Various groups have shown that the Rho-associated coiled coil-containing protein kinase (ROCK) pathway is involved in PVR pathogenesis; however, presence of rho-kinase in human PVR membranes has not yet been demonstrated. Therefore, we studied the ROCKsignaling in two different types of human ocular fibrotic membranes, namely in surgically excised human PVR and epiretinal membranes (ERM). Methods: Membranes were obtained during vitreoretinal surgery from 6 patient eyes with proliferative vitreoretinopathy (PVR) and 12 eyes with epiretinal membranes (ERM). Immunohistochemistry staining for hematoxylin and eosin, collagen 1, alpha-smooth muscle actin (a-SMA) and rho-kinase isoforms (ROCK1 and ROCK2) were performed. In addition, RT-PCR was performed to determine ROCK isoform gene expression levels. Results: Different fibrotic markers, such as collagen 1 and a-SMA were detected together with ROCK1 and ROCK2 in PVR and ERM membranes. ROCK1 gene expression was more abundant than ROCK2 in ocular fibrotic membranes. Conclusions: The current results indicate that rho-kinase is expressed in human ocular fibrotic membranes, such as PVR and ERM, and might play a role in its formation.


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Saturday, 4 JUNE Session IVb (11.10 am – 12.00 n) Ivb5 (PP): RIPK Necrotic Cell Death Pathway in Both Donor Photoreceptor and Host Immune Cells Synergize to Affect Photoreceptor Graft Survival. Vavvas D1, Maidana D2, Gonzalez-Buendia L1, Miller J1 1

Mass Eye and Ear Infirmary UIC

2

Background: Photoreceptor transplant has been put forward as a repair strategy to tackle degenerated retinas. Nonetheless, cell death and immune rejection seriously limit the success of this strategy, with only a small fraction of transplanted cells surviving. Improving the survival of transplanted cells is of critical importance. Recent evidence has identified receptor-interacting protein kinase 3 (RIPK3) as a molecular trigger controlling necroptotic cell death and inflammation. However, its role in photoreceptor transplantation and regenerative medicine has not been studied. Methods: We hypothesized that modulation of RIPK3 to address both cell death and immunity could have advantageous effects on photoreceptor survival. Using a pre-clinical model of inherited retinal degeneration, we investigated the effect of RIPK3 pathway in donors and recipients and analyzed its effect on graft survival. Findings: In a model of inherited retinal degeneration, deletion of RIPK3 in donor photoreceptor precursors significantly increases the survival of transplanted cells. Simultaneous RIPK3 deletion in donor photoreceptors and recipients maximizes graft survival. Lastly, to discern the role of RIPK3 in the host immune response, bone marrow transplant experiments demonstrated that peripheral immune cell RIPK3 deficiency is protective for both donor and host photoreceptor survival. Interestingly, this finding is independent of photoreceptor transplantation, as the peripheral protective effect is also observed in an additional retinal detachment photoreceptor degeneration model. Interpretation: Altogether, these results indicate that immunomodulatory and neuroprotective strategies targeting the RIPK3 pathway can aid regenerative therapies of photoreceptor transplantation.


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Elounda Crete 3rd - 5th of June 2022

Sunday, 5 JUNE Session Va (9.15 am – 10.10 am) Va1 (PP): Central Serous Chorioretinopathy and Subthreshold Micro-pulse Laser Photocoagulation. Kontadakis G, Lygerou M, Karageorgiou G, Tzanidaki M, Datseris I OMMA Ophthalmological Institute of Athens Introduction: The purpose of this study is to present the use of Subthreshold Micropulse laser treatment in patients with central serous chorioretinopathy (CSC). Methods: This is a case series of 20 patients that presented with CSC. All patients were administered Subthreshold Micropulse laser Photocoagulation and were followed for at least 1 year. Results: In all cases CSC had completely resolved up to 4 months after treatment, with statistically significant improvement of vision of 9±3.6 letters LogMAR on average. The condition remained stable with no relapse during follow up. Conclusion: Observation is currently standard of care for newly presenting cases along with cessation of corticosteroids, if possible, as well as life-style modifications including stress reduction. For chronic CSC, recurrent CSC, and acute CSC in functionally monocular patients, treatment is argued. The mainstay of treatment is currently photodynamic therapy, however treatment with Subthreshold Micropulse laser is gaining momentum. In our cases the results were encouraging in terms of anatomy and vision improvement without recurrences during follow up, thus supporting this technique.


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Sunday, 5 JUNE Session Va (9.15 am - 10.10 am) Va2 (PP): Five-year progression of myopic maculopathy in patients with degenerative myopia. Bontzos G1,2, Xirou T1, Gkiala A1, Smoustopoulos G1, Gkizis I1, Kontou E1, Kabanarou S1, Tsilimbaris M2 1

Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece. Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece.

2

Purpose: The prevalence of myopia and degenerative myopia has been increasing rapidly worldwide and has a huge public impact because of the concomitant increase in potentially blinding complication associated with myopia. The purpose of this study is to investigate the natural history myopic maculopathy findings in patients with high myopia. Methods: Retrospective study. In total, we reviewed 72 patient records with a minimum 5-year follow-up period. Patients were classified as high myopic with a refractive error greater than 6 D or an axial length greater than 26.5 mm. The data related to patients' information and medical history were retrieved from medical records. Standard ophthalmological examination was performed for the enrolled patients, including best corrected visual acuity (BCVA), optical coherence tomography (OCT) and slit lamp examination of the anterior and the posterior segment. In cases of suspected myopic choroidal neovascularization (CNV), diagnosis was confirmed by fluorescein angiography (FA). Results: Seventy two eyes (72 subjects) were included in this study, with 41.28% (29) male and 59.72% (43) female. The mean age of patients was 54.57 ± 14.38 years (range 25 to 81). Central retinal thickness was 261.55 ± 19.76 µm. In the following table we report the macular findings of our study pool. Over a 5-year period, progression from diffuse to patchy pattern of atrophy was noted in 16.7% of patients, while new lacquer cracks appeared in 4.2% of patients. Myopic CNV was developed in 5.6% of patients. Conclusions: Lesion characteristics in myopic degeneration have been elucidated after technological advancement in retinal imaging. Understanding disease patterns and progression is essential for appropriate management of patients. Discovering biomarkers which will lead to CNV development of urgent importance to establish international diagnostic criteria and treatment protocols.


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Elounda Crete 3rd - 5th of June 2022

Sunday, 5 JUNE Session Va (9.15 am - 10.10 am) Va3 (PP): Evolution of macular atrophy in eyes with neovascular age-related macular degeneration treated with anti-VEGF agents compared to fellow non-neovascular eyes. Blazaki S1, Blavakis E1, Bontzos G2, Smoustopoulos G2, Dimitriou E3, Chatziralli E.3, Stavrakakis A1, Kabanarou S2, Xirou T2, Chlouverakis G4, Tsilimbaris M1, 1

Department of Ophthalmology, University Ηospital of Heraklion, Greece Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece 3 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece 4 Laboratory of Biostatistics, Faculty of Medicine, University of Crete, Greece 2

Purpose: Τo evaluate the evolution of MA in patients with neovascular AMD (nAMD) treated with antivascular endothelial growth factor (anti-VEGF) agents, compared with their fellow eyes exhibiting dry AMD. Patients & methods: This retrospective study included 124 patients from three centers with neovascular AMD treated with anti-VEGF intravitreal injections in one eye and dry AMD in the fellow eye. We analyzed data from two groups of patients. Dataset 1 included 91 patients without MA at baseline in order to study time to first MA development in treated (TE) and fellow (FE) eyes, and dataset 2 included 83 patients with at least of 4 years of follow-up for studying time course and growth rate of MA in TE and FE. MA was evaluated using NIR images, while all available OCT images were used to confirm that the atrophic area fulfilled the criteria proposed by the Classification of Atrophy Meetings (CAM) group for cRORA. Results: In dataset 1 MA first detection in TE increased in significant levels from year to 2 to year 6 in comparison with FE. 45.% of TE developed MA, compared to 16.5% of FE (p<0.001): Repeated measures ANOVA revealed significant time (p<0.001), eye (p<0,001) and time eye interaction (p<0.001) effects. MA in treated eyes exhibited a steady significant increase up to year 6 , whereas in the FE the significant increased is halted at year 2. In dataset 2, the annual increase in TE was 0.275 mm/y; 0.10 mm/y for year 1, jumps to 0.23 mm/y for year 2 and to 0.37 mm/y for year 3, to 0.49 mm/y for year 4. The respective annual increase for FE was 0.110 mm/y; 0.09mm/y, 0.14mm/y, 0.11mm/y and 0.10mm/y. There was found no correlation between the number of injections and MA area. Conclusions: In this study we documented a significant difference in MA incidence and progression in eyes with nAMD compared to fellow eyes exhibiting dry AMD.; It seems that MA progresses in a faster rate in these eyes compared to fellow dry AMD eyes.


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Sunday, 5 JUNE Session Va (9.15 am - 10.10 am) Va4 (PP): Progression of macular atrophy in nAMD patients receiving long-term anti-VEGF therapy. Tsilimbaris M1, Blazaki S1, Blavakis E1, Smoustopoulos G2, Bontzos G2, Stavrakakis A1, Kabanarou S2, Xirou T2, Chlouverakis G3 1

Department of Ophthalmology, University Ηospital of Heraklion, Greece Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece 3 Biostatistics Laboratory, Faculty of Medicine, University of Crete, Greece 2

Purpose: To evaluate the progression of macular atrophy (MA) in patients with age-related macular degeneration (AMD), receiving anti-vascular endothelial growth factor (anti-VEGF) treatment for at least a 6-year period. Materials and Methods: This retrospective study included 53 naïve patients (53 eyes) with neovascular AMD from two centers, who were treated with anti-VEGF intravitreal injections and had no MA at baseline. MA was evaluated in an annual basis using NIR images, while all available OCT images were used to confirm that the atrophic area fulfilled the criteria proposed by the Classification of Atrophy Meetings (CAM) group for complete retinal pigment epithelium RPE and outer retinal atrophy (cRORA). Incidence and progression of MA were evaluated. Associations with best-corrected visual acuity (BCVA) and total number of injections were also studied. Results: Treatment duration of our patients was 7.34 ± 1.54 years. The mean number of anti-VEGF injections was 24.4 ± 13.6. BCVA at baseline was 0.38 ± 0.27 logMAR while at final visit it was 0.60 ± 0.35 logMAR (p=0.731). The cumulative incidence of new MA at years 1, 2, 3, 4, 5, and 6 was 1.89%, 18.87% 32.08%, 39.62%, 49.06% and 50.94% respectively. In patients who developed MA, mean MA area increased from zero at baseline to 5.66 ± 7.18 mm2 at final visit. The estimated annual enlargement of MA was 0.45 mm/year based on square root transformation (1.12 mm2/year, untransformed data). MA progression does not appear to be significantly associated with total number of injections (R=0.133; p=0.255). Conclusion: In this real-life setting, half of neovascular AMD patients under anti-VEGF treatment, without MA at therapy initiation, developed MA over a period of at least 6 years. In this work, the number of injections did not seem to have a significant association with MA progression.


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Elounda Crete 3rd - 5th of June 2022

Sunday, 5 JUNE Session Vb (10.10 am - 11.50 am) Vb1 (PP): Optical coherence tomography angiography in patients with systemic scleroderma. Ioannidi L1, Repa A2, Seliniotakis K1, Bertsias G2, Sidiropoulos P2, Tsilimbaris M1 1

Department of Ophthalmology, University Hospital of Heraklion, Heraklion Crete, Greece Department of Rheumatology and Clinical Immunology, University Hospital of Heraklion, Heraklion Crete, Greece 2

Purpose: Systemic scleroderma is an autoimmune disease characterized by macro- and micro-vascular dysfunction. We sought to evaluate the morphological findings in the microvasculature of the ocular posterior segment in patients with systemic scleroderma. Materials & Methods: For the purposes of our study, patients with systemic scleroderma (SSc) and a control group of healthy individuals with no history of ophthalmological condition, were examined in association with the Department of Rheumatology & Clinical Immunology at the University Hospital of Heraklion. A classification of SSc, a complete physical exam and nailfold capillaroscopy were executed by a rheumatology specialist. Patients with SSc and control group underwent complete ophthalmology examination including optical coherence tomography (OCT) using Heidelberg-Spectralis and optical coherence tomography angiography (OCTA) using AngioVue, Optovue. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy and fundoscopy were performed prior to oct and oct angiography. Peripapillary retinal nerve fiber layer (RNFL), scanning of a 3mm x 3mm area of the macula and a 4.5mm x 4.5mm area of the optic disc were obtained and vessel density (%) in the superficial and deep capillary plexus including measurement of the foveal avascular zone (FAZ)(mm2) and thickness of ILM-RPE (µm) were estimated using the standard algorithm of the device (Angioanalytics). Results: 38 eyes (19 patients: 17 female/2 male, mean age: 54.68 yo ± 13.35) with SSc and a control group (20 patients: 18 female/2 male, mean age: 55,2 ± 12.03) were included. No significant morphological differences were found regarding the vessel density in both superficial (SSc: 44.68 ± 3.81, control: 45.52 ± 2.64, p>0.01) and deep capillary plexus (SSc: 50.4 ± 3.5, control: 49.98 ± 3.28, p>0.01). Thickness of ILMRPE (SSc: 308.79 ± 15.51, control: 317.71 ± 15.86, p>0.01) and FAZ size area (SSc: 0.270 ± 0.09, control: 0.265 ± 0.11, p>0.01) were recorded; also, minor differences between capillary density of the optic disc (SSc: 50.28 ± 2.25, p>0.01, control: 49.31 ± 2.46, p>0.01) and RNFL changes between all sectors (p>0.01) were unremarkable. Conclusions: Although SSc is known to affect microcirculation in various tissues, our findings do not support the existence of a significant involvement of retinal perifoveal or peripapillary microcirculation in SSc. Further research in a larger sample is necessary to reveal possible subtle morphological changes and confirm the spearing of retinal microcirculation in SSc.


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Sunday, 5 JUNE Session Vb (10.10 am - 11.50 am) Vb2 (PP): Evaluation of silicone oil effect on visual electrophysiology in patients with retinal detachment. Papachristou A1,2, Lambraki A1, Giannakopoulou T1,2, Plainis S1, Tsilimbaris MK1,2 1

Laboratory of Optics and Vision, School of Medicine, University of Crete, Heraklion, Greece Ophthalmology Department, University Hospital of Heraklion, Heraklion, Greece

2

Purpose: Silicone oil is a useful material in cases of surgical management of a retinal detachment, used as a tamponade to maintain the retina reattached, when it is indicated. It has been reported that silicone oil, when in eye, results to reduced electrophysiological responses of retinal cells, which may be due to its insulating effect. To our knowledge, there does not exist a study that incorporates VEPs in together with full field ERGs, when it comes to evaluation of silicon oil on visual electrophysiology. The purpose of this study was to investigate the hypothesis that silicone oil causes insulation effects on photoreceptors and other retinal cells, by affecting their responses on visual electrophysiology. Methods: Electrophysiological responses to a flash stimulus were recorded using full-field electroretinography (ERG) and visual evoked potentials (VEP). Recordings were performed in 9 patients, with an average age of 63±12 years before (1-2 days) and after (2-3 weeks) the removal of silicone oil in both the study eye and the other eye, which served as control. Flash ERG recordings were performed in photopic and scotopic conditions, while flash VEP recordings in photopic conditions, using the ISCEV standard protocol and the Primus 2.5 system (Tomey, Germany). Surgery for retinal detachment and subsequent silicon oil removal was performed in the Ophthalmology Clinic, University Hospital of Heraklion, Crete, Greece. Results: Statistically significant differences were found in the amplitudes of the ERG responses in the study eye before and after removal of the silicone oil in all conditions tested, while this was not observed in the other eye. More specifically, in photopic conditions, the mean ratio (after/before) of the flash ERG response for the control eye was 1.1 ± 0.4, while for the study eye was 2.8 ± 1.4 (p=0.003). Moreover, the mean ratio of ERG flicker response was 0.9 ± 0.3 and 2.9 ± 2.5 for the control and study eye, respectively (p = 0.03). In scotopic conditions, the mean ratio for the strong flash ERG responses before were 1.1±0.6 for the control eye and 1.8±0.7 for the study eye (p = 0.038), while the corresponding values for the dim flash were 1.2±0.6 and 5.7±4.1 (p = 0.005). In contrary, no significant differences were observed for the amplitude and latency time of flash VEP response before and after silicone removal both for the control and the study eyes: the ratio in P100 amplitude before and after silicone removal was 1.0±0.2 for the control eye and 1.2±0.6 for the study eye, (p = 0.965), while the difference in P100 latency was 3.1±4.1 s and 3.9±3.9 s respectively (p = 0.985). Conclusions: The present study demonstrates that silicone oil causes a reduction in flash responses that originate from retinal cells (full field ERG) while not affecting the responses recorded by the flash VEP. The photoreceptors seem to recover after silicone oil removal. When it comes to evaluating the retinal function with visual electrophysiology, results in eyes filled with silicone oil are not reliable, and those ERGs should not be considered representative of the photoreceptors' fuction. In contrast VEPs, are not affected by the means of the endotamponade. These changes in ERG support the hypothesis that silicone oil, used as an endotamponade in patients with retinal detachment, interferes as a insulation rather than causing retinal toxicity.


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Elounda Crete 3rd - 5th of June 2022

Sunday, 5 JUNE Session Vb (10.10 am - 11.50 am) Vb3 (CR): Unpleasant surprise after uncomplicated phacoemulcification in one-eye patient. Stavrakakis A Department of Ophthalmology, University Hospital of Heraklion, Heraklion Crete, Greece Purpose: To report a case of visual loss in an one eye patient after catact surgery. Material: A 65 year old lady with a history of phthisis bulbi in one eye after trauma in childhood, underwent cataract surgery in her good eye without complications. On the first day post-op visual acuity was 20/200 despite clear media. Fundoscopy revealed white spots at the level of the retinal pigment epithelium at the macular with edema. Oct showed accumulation of large amount of fluid in the subretinal space with concomitant cystoid macular edema. Results: Patient's visual acuity gradually improved over time without any intervention. Cefuroxime toxicity has been reported mainly after overdose due to dilution error. Conclusions: Despite immediate reduction of visual function, cefuroxime toxicity does not require intervention as it's effect usually faint over time.


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Sunday, 5 JUNE Session Vb (10.10 am - 11.50 am) Vb4 (PP): Peripapillary changes of Retinal Nerve Fiber Layer after a successful surgery for rhegmatogenous retinal detachment. Stavrakakis A1, Vlachou A1, Tsoka P2, Tsilimbaris M1,2 1

Department of Ophthalmology, University Ηospital of Heraklion, Greece Laboratory of Vision and Optics, University of Crete, Greece

2

Purpose: To investigate possible changes in peripapillary retinal nerve fibre layer (RNFL) after successful surgery for rhegmatogenous retinal detachment (RRD). Methods: Forty six eyes, which underwent surgery for primary RRD, were included in the study. Successful surgery was performed either by pars plana vitrectomy, retinopexy and SF6 gas tamponade or pneumatic retinopexy. Exclusion criteria were known conditions that can cause changes to the RNFL (e.g. history of glaucoma) or surgery that demanded extensive manipulations. Spectral-domain optical coherence tomography (SD-OCT) was used for the measurement of the peripapillary RNFL. Values calculated by the device in 6 peripapillary sectors were used. Measurements at 1,6 and 12 months' time post-operative were compared. The segments that are corresponding to the detached area were highlighted. The most affected sector was compared. Control eye was the corresponding sector of the fellow eye at each time point. A comparison of the least affected area of the detached and the fellow eye was also made. Demographic and clinical characteristics of patients were also recorded. Twelve patients have completed the 12 month follow up. Results: 12 patients have completed the one year follow up and were compared. A statistically significant reduction of RNFLt over time was found after comparing values of the most affected sector of the detached eye at 1st, 6th and 12th month post-op (n=12, *P = 0,02). On the other hand, comparison of the same sector of the fellow eye did not reveal any change of the RNFL thickness over time (n=12, P =0,84). Finally, RNFLt values of the most unaffected sector of the detached eye were compared at 1st, 6th and 12th month and although a gradual reduction in thickness could be seen, this change did not reach statistical significance (n = 12, P = 0,06). The corresponding sector in the fellow eye did not reveal any change of the RNFLt (n = 12, P = 0,61). Conclusions: The peripapillary RNFL values in the segments related to the detached retina seem to be affected over time despite successful retinal detachment repair.


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Elounda Crete 3rd - 5th of June 2022


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aegean retina XVII

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