The 9th Asia Cornea Society in conjunction with The 7th INASCRS Biennial Scientific Meeting 2024

Abstract Title
Role of Phacoemulsification in Managing Intraocular Pressure on Acute Glaucoma Patients at Achmad Wardi Eye Hospital

Introduction & Objectives
Phacoemulsification remains the only therapy that restore the anatomical root cause of angle closure disease, including in acute glaucoma. Low rate of success in management of acute glaucoma by laser peripheral iridotomy (LPI) only in Asian patients has magnify the importance of phacoemulsification in such patients. To evaluate characteristics of patients, and intraocular pressure (IOP) reduction following phacoemulsification in patients with acute glaucoma.

Methods
This is a retrospective descriptive study. Data from patients with acute glaucoma who underwent phacoemulsification from January 2021 to December 2023 is included, and will be excluded if follow up data from primary timepoint in 1 month postoperative can not be obtained.

Results
Data from 41 eyes of 40 patients were analyzed. Female patients is much higher than male (77.50% vs 22.50%) with an average age of all patients is 60.29 ± 6,798 years. The average IOP at first presentation was 38.92 ± 16,996 mmHg, then decreased to 19.44 ± 10.545, 14.98 ± 8.469, 17.52 ± 7.127 at 1 day, 1 week and 1 month following phacoemulsification. Visual acuity is worse than 3 meter finger counting in 58,54% of patients, this is unsurprising as 63,41% patients presented to our center more than a week following their initial symptoms.

Conclusion
Phacoemulsification remains one of the most important strategy in management of acute glaucoma. However, success of phacoemulsification in terms of IOP management and visual recovery is highly influenced by duration and severity of the attack.

Keyword
KEYWORDS: Phacoemulsification, Acute glaucoma, intraocular pressure.

Abstract Title
From Crisis to Clarity: Overcoming Unfortunate Intravitreal Injection-Induced Traumatic Cataract with Bimanual Lens Aspiration

Introduction & Objectives
To present the management of unfortunate traumatic cataract after intravitreal injection using bimanual approach lens aspiration.

Methods
A 58-year-old female came to outpatient clinic just one day after an intravitreal injection due to sudden visual loss in the left eye. The symptoms occurred directly after patient came home from the injection. Patient had previously been diagnosed with wet age-related macular degeneration. Presenting visual acuity was 1/300 compared to pre injection at 6/12. Lens opacity with suspected needle tract was identified from superotemporal to inferonasal with inability to identify the posterior capsule. Ultrasound showed haziness in anterior vitreous. Patient was diagnosed with traumatic cataract with suspected posterior capsule rupture.

Results
Phacoemulsification was performed with caution of posterior capsule rupture. Hydrodissection and hydrodelineation were performed gently to avoid further damaging the posterior capsule. Procedure proceeds with low settings of intraocular pressure, aspiration flow, and vacuum with coaxial approach at first. Halfway, with identification of non-stable anterior chamber as sign for possible posterior capsule rupture, it was decided to use bimanual approach/h. When posterior capsule rupture was identified, lens was moved anteriorly and dispersive viscoelastic was emplaced into the posterior capsule bag to forestall vitreous prolapse. Anterior vitrectomy was done to clear any remaining vitreous. At the end, post operative patient uncorrected visual acuity was 6/9 and became 6/6 with correction 3 weeks after the procedure.

Conclusion
Intravitreal injection could cause posterior capsule rupture. Low settings bimanual approach lens aspiration is recommended as the modality for more controlled maneuver in this case.

Keyword
Traumatic Cataract, Intravitreal injection, Bimanual lens aspiration

Abstract Title
Outcomes of Simple Limbal Epithelial Transplantation Without Amniotic Membrane Grafting in Unilateral Stem Cell Deficiency

Introduction & Objectives
We describe the technique of simple limbal epithelial transplantation (SLET) without amniotic membrane grafting (AMG) in limbal stem cell deficiency (LSCD).

Methods
Retrospective, interventional case series of eight patients who underwent SLET without AMG was included. Standard surgical technique was followed. Resection of symblephera and pannus dissection in the affected eye was done where needed. A limbal biopsy was obtained from the healthy eye. Following host bed preparation, limbal explants were placed on the bare cornea and secured with fibrin glue, and a large-diameter bandage contact lens was applied. No amniotic membrane was utilized. Pre-operative (age, gender, cause of LSCD, best-corrected visual acuity (BCVA), and previous ocular surgeries) and post-operative clinical information (follow-up duration and recurrence of LSCD, BCVA, and other ocular examination findings) was recorded.

Results
Pre-operatively, three patients had total LSCD (secondary to Firecracker injury, chemical injury, and excision biopsy for ocular surface squamous neoplasia (OSSN). Five patients had partial LSCD (4 chemical injuries, 1 firecracker injury). The mean age of participants was 30.67 ± 15.91 years. The mean follow-up duration was 9.33 ± 8.04 months. Intraoperatively, all patients had a smooth corneal surface after pannus removal. Post-operatively, complete corneal epithelization was noted within two to three weeks. All limbal explants remained securely attached and no loss of explants occurred in any patient. The ocular surface remained stable throughout, and no recurrence of LSCD was observed in any patient.

Conclusion
The present series suggests that AMG may not be necessary for performing SLET.

Keyword
Simple limbal epithelial transplantation, without amniotic membrane grafting, corneal clarity

Abstract Title
Evaluation of Cataract Surgery Without Endophthalmitis and PCO with Phacoemulsification Techniques for 5 Years in Peripheral Areas

Introduction & Objectives
The goal is to evaluate cataract surgery with phacoemulsification in the last 5th peripheral area. Which each operation has a minimum of 10 patients and a maximum of 20 patients. April 2019 s/d March 2024. The number of patients operated in that timeframe.2400 patients and no endophthalmitis found on control day 1 and 1 week after surgery and 1 billion after surgery. The location of the operation is in the peripheral area of RSUD ADJIDARMO. All patients are BPJS patients.

Methods
Data collected from medical records on the computer. Special operating room for eye surgery only. Before surgery, the operating room was sterilized. Patients before surgery are qualified in surgery with when there are abnormalities of diabetes and hypertension, already controlled. Postoperative therapy is, eye drops; antibiotics + steroids (Tobramycin + steroid), antibiotics (Moxifloxacin) drops used every hour for the first 3 days then 6 times a day. After 3 day. For 7 days . Technique of operation were various kind depend on the grade and density of each cataract. Type of technique werw stop and chop , divide and conquere and quick chop. iol is hydropobic type.

Results
No endofthalmitis and PCO were found in all of the patients. Advanced vision sharp with a significance range of 0.8 s/d 1.0 without correction.

Conclusion
1.The use of the operating room is specifically for eye surgery. 2 .the type of eye drop used and how to use it , 3.intra operative sterilization and flow of patients. are variables of indicators that tend to influence the outcome of this operation.

Keyword
Operating Room , Only for eye surgery . Eye drop. 3 day every 1 our in 3 day . No Endofthalmitis and PCO

Abstract Title
Genetic Profile of Anterior Segment Development Anomalies in Asian Indian Population

Introduction & Objectives
Anterior Segment Developmental Anomalies (ASDA) encompass disorders affecting the eye's anterior segment, presenting with corneal opacities in infancy .Genetic testing improves diagnosis accuracy ,prognosis and mechanism-specific care. ASDA shows genotypic and phenotypic heterogeneity, with limited data on mutation spectra and genotype-phenotype correlation in the Asian-Indian population. This study aimed to investigate molecular genetic patterns in ASDA with primary corneal involvement and evaluate genotype-phenotype characteristics in the Asian-Indian population.

Methods
A case-control study included 29 ASDA patients (≤14 years) with primary corneal opacity and 29 healthy controls. Parameters included demographics, clinical history, visual acuity, comprehensive ophthalmic examination, intraocular pressure, axial length, imaging (UBM, ultrasonography, i-OCT), flash VER and targeted gene sequencing. Genotype-phenotype correlation analyzed clinical characteristics such as axial length, corneal diameter, corneal opacity, KID, KILD, posterior segment anomalies and systemic anomalies.

Results
Among 29 ASDA cases (mean age 9.52 ± 13.8 months; males 15, females 14), 68.9% had bilateral presentation. Genetic mutations were found in 19 patients( 65.5%).Predominant phenotypes included microphthalmos, microcornea, glaucoma, posterior segment anomalies, systemic anomalies, KID, aniridia, congenital aphakia and anomalous limbus. Mutations included FOXC1, FOXE3, CYP1B1, TENM3, PXDN, HCCS, OTX2, FGFR2, LRP5, VSX1, chr4g deletion, RDH11, SLC16A12, B3GLCT. Syndromic associations and posterior segment anomalies were linked to specific mutations.

Conclusion
This study identified diverse mutations associated with ASDA and their varied genotype-phenotype correlations, highlighting uncommon mutations like TENM3, PXDN, HCCS, OTX2, LRP5, VSX1, chr4g deletion, and SLC16A12 as causative. Syndromic manifestations and posterior segment anomalies were associated with specific mutations, emphasizing the importance of comprehensive evaluation in ASDA patients.

Keyword
ASDA, Genetic mutation, Genotype-phenotype correlation

Abstract Title
Clinical Characteristics and Refractive Outcomes of Cataract Surgery with Negative-Power Intraocular Lens Implantation

Introduction & Objectives
Cataract surgery in patients with high myopia can result in unpredictable refractive outcomes. In this study, we describe the clinical characteristics and refractive outcomes of cataract surgery with negative-power intraocular lens implantation in highly myopic patients.

Methods
This retrospective study was conducted in JEC Eye Hospital brances Menteng and Kedoya, both in Jakarta, Indonesia. Highly myopic cataract patients who underwent cataract surgery with negative-power IOL implantation in our hospitals from January 2020 to February 2022, were included in our study. Patients with preexisting ocular disease which caused a decrease visual acuity that was unrelated to their previous surgery, incomplete data, and patients who did not attend their follow-up visit 1 month after surgery were excluded. Spherical equivalent (SE) was measured 1 week, 1 month, and >1 month after surgery and classified into three groups - hyperopic shift, myopic shift, and a constant group.

Results
A total of 36 subjects were included in this study. Twenty-two patients (61.11%) experienced hyperopic shift after surgery. There was no significant difference in axial length, target refraction, SE, keratometry, mean absolute error (MAE) and use of capsular tension ring (CTR) between hyperopic shift, myopic shift, and constant group (p>0.05).

Conclusion
Most patients reported hyperopic shift after surgery. It is also suggested to aim for low myopia in eyes with extreme axial length due to the frequency of hyperopic shift and because these patients were accustomed to myopia. Additionally, in all three of groups there were no significant difference of use of CTR, keratometry values, and MAE.

Keyword
high myopia; cataract surgery; negative-power IOL; keratometry; hyperopic shift

Abstract Title
Comparative Study of DMEK and Ultrathin DSAEK Combined With Cataract Surgery

Introduction & Objectives
To analyze the refractive and visual outcomes after UT-DSAEK or DMEK combined with cataract surgery (triple procedure), and to evaluate the appropriate surgical method based on the patient’s condition in the South Korean population.

Methods
We retrospectively analyzed the medical records of 35 patients who underwent DMEK triple and 29 patients who underwent UT-DSAEK triple at Seoul St. Mary’s Hospital from 2013 to 2023. Based on outcomes at 1, 3, 6, and 12 months postoperatively, we analyzed the prediction error, BCVA and compared the surgical results by dividing the patients into subgroups of those with Fuchs’ dystrophy and those with other conditions.

Results
The mean prediction error showed significant difference at all postoperative time points, with the DMEK group exhibiting a myopic error relative to the target, and the DSAEK group exhibiting a hyperopic error. The proportion of patients achieving a BCVA of 20/25 or better at 1, 3, 6, and 12 months was 17.1%, 40.0%, 40.0%, and 44.4% for the DMEK triple group, and 3.4%, 10.3%, 26.0%, and 23.1% for the DSAEK triple group. Within the DMEK triple group, the non-Fuchs’ subgroup showed more myopic prediction errors and steeper postoperative K.

Conclusion
The DMEK triple group exhibited myopic error, while the DSAEK triple group exhibited hyperopic error. In patients with good visual potential, such as Fuchs’ dystrophy, DMEK triple group showed better visual outcome. For complicated conditions, such as ACG or uveitis, UT-DSAEK triple could be the primary choice.

Keyword
DMEK triple, UT-DSAEK triple, corneal transplantation

Abstract Title
Self-Monitoring of Subconjunctival Hemorrhages Using the Portable Slit-Lamp 'Smart Eye Camera': A Single Case Report

Introduction & Objectives
Subconjunctival hemorrhage (SCH) is commonly followed up with no treatment, and improvement is often seen in about 2 weeks. In this case, SCH developed and was monitored online using a portable slit-lamp microscope (SEC). We report a case of SCH that was cured with the daily follow-up using SEC.

Methods
A 39-year-old Japanese male professional athlete. He had a history of atopic dermatitis and was using orthokeratology. On the afternoon of the 1st day, his family pointed out the redness of his left eye, and he used SEC to take the self-taken slit images, diffuse light, and blue light after 0.5% fluorescein self-injection of the left eye.

Results
An online consultation with an ophthalmologist was performed and a diagnosis of a left SCH was made. The patient took self portraits every day upon waking up and in the evening, and by the 9th day of the disease, there was marked improvement, and the patient was cured on the 19th day.

Conclusion
This is the first report of a case in which the healing process of SCH was followed by daily imaging. In principle, ophthalmology is a face-to-face ophthalmology practice, but in the context of diagnostic imaging, it is possible to remotely monitor the progress of some diseases by combining online medical services. However, we believe that this report should not be an obstacle to face-to-face ophthalmologic care.

Keyword
Smart Eye Camera, Subconjunctival hemorrhage, Remote medicine

Abstract Title
Evaluation of Visual, Refractive Outcome, and Changes in the Ocular Parameters After EyeCryl Phakic IOL Implantation in Patients with Moderate to High Myopia and Astigmatism: A Prospective Comparative Study with EVO/EVO+ Visian Implantable Lenses

Introduction & Objectives
INTRODUCTION: Phakic intraocular lenses are effective for correcting high myopia. Newer phakic IOLs are delivering promising results. OBJECTIVES: To evaluate and compare the visual and refractive outcome after implantation of Eyecryl, a hydrophilic acrylic phakic intraocular lens implant from Biotech Vision Care (EP IOL) in moderate to high myopia and astigmatism with an established method using Visian Implantable Collamer Lenses (EVO/EVO+ latest model of ICL, STAAR Surgical

Methods
METHODS: This study included patients with high myopia and myopic astigmatism who underwent either Eyecryl pIOL or ICL (EVO/EVO +) lens implantation. Both the lenses were compared for 6 months to assess the visual, refractive outcome, rotational stability and changes in the ocular parameters and adverse events after implantation.

Results
RESULTS: A total of 82 patients (164 eyes) were enrolled of which Group 1 of 41 patients (82 eyes) recieved EP IOL and Group 2 of 41 patients (82 eyes) recieved ICL implantation. Preoperative mean ± standard deviation of spherical equivalent (SE) and cylinder was -9.17 ± 4.20 and 1.32 ± 1.04 diopters (D) in Group 1 and -8.53 ± 4.71 and -1.17 ± 0.99 D in Group 2, respectively. At 6 months of follow-up, there was no significant difference between the mean uncorrected distance visual acuity, corrected distance visual acuity and residual astigmatism between the two groups (P > 0.05).

Conclusion
CONCLUSIONS: Both the phakic IOLs showed comparable outcomes in safety, stability and effectively correcting high myopia and myopic astigmatism at 1 month, 3 months and 6 months postoperatively.

Keyword
Phakic intraocular lens, EVO/EVO+ ICL, Eyecryl Phakic IOL

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