FP2 Symposium

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Date : September 27, 2024 Time : 14:00 - 15:30 (GMT+7) Venue : Axel Add To Google Calendar Add To Microsoft 365

Chairs:

Kyung-Sun NA, MD - South Korea
Angga FAJRIANSYAH, MD - Indonesia

Topics

The Role of Ascorbic Acid in Corneal Endothelial Damage Related to Cataract Surgery

14:00 - 14:05 (5 mins.)

Valerie GRACIA, MD - Jakarta

Abstract Detail

Abstract Title
The Role of Ascorbic Acid in Corneal Endothelial Damage Related to Cataract Surgery

Introduction & Objectives
Ascorbic acid has been proposed as an alternative therapy to minimize corneal endothelial decompensation generated during cataract surgery. Many studies have investigated the beneficial effects of ascorbic acid on the corneal endothelium. However, it is still not established that ascorbic acid can aid improvement after cataract surgery. This study aims to review what we know so far about the role of ascorbic acid in ameliorating corneal endothelial damage related to cataract surgery and the underlying mechanism.

Methods
Using PRISMA 2020 Guidelines, six studies, ranging from 2011 to 2020, were included in this review. Parameters observed include endothelial cell density (ECD), corneal thickness, marker of cell apoptosis and proliferation, and total protein content of corneas.

Results
Findings showed improvement of corneal transparency, enhancement of expression of Bcl2 (anti-apoptotic protein), a significant increase of ERK phosphorylation (which stimulates proliferation), and a significant increase in proliferation. Significant difference in corneal endothelial cells loss was also found in two studies (9,10  6,88% vs 14,85  10,54% on control group) and (3.26% vs 13.8% on control group).

Conclusion
Most studies currently available are animal studies and the results support ascorbic acid as a protective agent to minimize corneal endothelial damage in patients undergoing cataract surgery. More randomized clinical trials are needed to further explore optimal dosage and administration in clinical use.

Keyword
ascorbic acid; corneal endothelial cells; cataract surgery; phacoemulsification; SICS

Using Artificial Intelligence for An Efficient Prediction of Outcomes of Deep Anterior Lamellar Keratoplasty (DALK) in Advanced Keratoconus

14:05 - 14:10 (5 mins.)

Gairik KUNDU, MD - India

Abstract Detail

Abstract Title
Using Artificial Intelligence for An Efficient Prediction of Outcomes of Deep Anterior Lamellar Keratoplasty (DALK) in Advanced Keratoconus

Introduction & Objectives
To identify and analyze clinical risk factors and imaging parameters influencing the outcomes of deep anterior lamellar keratoplasty (DALK) for advanced keratoconus (KC) using an artificial intelligence (AI) model.

Methods
250 DALK eyes with a 5-year follow-up for advanced KC were included. The DALK eyes were classified as having “favorable” or “unfavorable” outcomes based on graft clarity, scarring at graft host interface involving the visual axis which was not pre-existing, early suture loosening less than 3 months from the surgery, corneal vascularisation reaching up to or into graft host junction at any follow up period, persistent corneal edema greater than 3 months post surgery and change in visual acuity. Clinical risk factors were determined through a detailed clinical evaluation and questionnaire assessment which included presence of systemic allergy, ocular allergy, eye rubbing. Immunoglobulin E (IgE),Vitamin D and B12 from blood investigations. A total of 37 tomographic parameters were exported from Pentacam HR. An AI model was then built to assess these risk factors and imaging parameters. The area under the curve (AUC) and other metrics were evaluated.

Results
The AI model classified 92.2% and 89.4% cases as favorable or unfavorable respectively based on clinical risk factors and imaging parameters. Systemic allergy, IgE, eye rubbing and Vitamin D had highest information gain followed by posterior corneal data from Pentacam HR. The AI model achieved an area under the curve of 0.957 with sensitivity of 98% and specificity of 85.6%.

Conclusion
This demonstrates importance of pre-operative risk stratification which can affect surgical outcomes of DALK.

Keyword
DALK,Risk factors, AI(Artificial intelligence)

Descemet Membrane Endothelial Keratoplasty (DMEK) in The Philippines: A Landmark Case Series

14:10 - 14:15 (5 mins.)

Jayvee Santos RIVERA, MD - Philippines

Abstract Detail

Abstract Title
Descemet Membrane Endothelial Keratoplasty (DMEK) in The Philippines: A Landmark Case Series

Introduction & Objectives
Despite its proven success in various parts of the world, the adoption of DMEK in Southeast Asia, particularly in the Philippines, has been relatively limited. This paper presents a pioneering review that aims to determine the one-year clinical outcomes of DMEK performed in the Philippines.

Methods
Cross-sectional chart review from 2018 to 2023.

Results
Thirty eyes (mean age 67.5 years; 66.7% female) underwent DMEK by a single surgeon for bullous keratopathy (50%), Fuchs' endothelial dystrophy (43%), and failed grafts (7%). Donor cornea mean age was 46.9 years, mean endothelial cell density (ECD) was 2,823.6 cells/mm2, and mean harvest-to-surgery was 6.8 days. The most common complication was partial graft detachment requiring rebubbling (26.6%). CDVA improved from preoperative 1.3 logMAR to 0.18 at 3 months and then remained stable up to 1 year postoperatively. Donor ECD loss was 62.2% at 1 year postoperatively. One eye (3.3%) had primary transplant failure. Of the eyes with partial graft detachment, 71.4% achieved a visual acuity of 0.3 logMAR or better at 3 months postoperatively. No immune rejection was observed in this cohort at 1 year postoperatively. Overall graft survival rate after DMEK was 85.7% at 1-year follow-up.

Conclusion
DMEK offers early and excellent visual recovery along with low complication rates and high graft survival rates at 1 year postoperatively. This review serves as a foundation for future long-term clinical outcomes of DMEK in the Philippines.

Keyword
DMEK, Philippines, Outcomes

Phacotime in Cataract Surgery Using the Phaco-Horizontal-Chop Technique Versus Vertical-Chop with Various Degrees of Lens Hardness

14:15 - 14:20 (5 mins.)

Imam MASDUKI, MD - Bantul

Abstract Detail

Abstract Title
Phacotime in Cataract Surgery Using the Phaco-Horizontal-Chop Technique Versus Vertical-Chop with Various Degrees of Lens Hardness

Introduction & Objectives
Currently, the most commonly performed cataract surgery is the phacoemulsification method. The horizontal chop and vertical chop techniques are quite effective and often done. In phacoemulsification, it is known that there is a term phaco time or U/S time, which is the total time to use ultrasonic energy that flows into the eye during surgery. This is a parameter that is assessed in phacoemulsification. To assess differences in phacotime scores in cataracts of various degrees operated with the phaco-horizontal-chop versus vertical-chop technique.

Methods
This study was a comparative analytical study with a total of 116 subjects, consisting of 52 subjects undergoing surgery with the horizontal-chop technique, and 64 subjects with the vertical-chop technique. The phaco time value is recorded at the end of each operation. Then data analysis was carried out with univariate and bivariate analysis using SPSS.

Results
The mean phacotime in this study was 47.35, with a median value of 43.50. For the minimum value of phacotime is 6 seconds while the maximum value is 117 seconds. The subjects in this study consisted of patients with various degrees of cataracts, including degrees 2 to 5. The results showed that there was a significant relationship between phacotime values in patients undergoing phacoemulsification cataract surgery using the horizontal-chop technique compared to the vertical-chop (p = 0.001).

Conclusion
There is a significant difference between the phacotime values in patients undergoing phacoemulsification cataract surgery using the horizontal-chop technique compared to the vertical-chop technique.

Keyword
Phacoemulsification, horizontal chop, vertical chop, phacotime

Accelerated versus Conventional Corneal Collagen Cross-Linking for Keratoconus: A Meta-Analysis of Randomized Trials

14:25 - 14:30 (5 mins.)

Chen KUAN-CHIEH, MD - Taiwan

Abstract Detail

Abstract Title
Accelerated versus Conventional Corneal Collagen Cross-Linking for Keratoconus: A Meta-Analysis of Randomized Trials

Introduction & Objectives
To systematically compare the effectiveness of conventional corneal collagen cross-linking (CCXL) protocols and accelerated corneal collagen cross-linking (ACXL) protocols in cases with progressive keratoconus.

Methods
The Cochrane library, EMBASE, MEDLINE, PubMed, and Web of Science databases were searched for randomized controlled trials (RCTs). Outcomes were clinical results and changes in corneal properties. Standardized mean differences (SMD) and 95% confidence interval (CI) were used to estimate the clinical consequences. All outcomes were distributed by different follow-up durations (6 months, 12 months, and > 12 months). We also compared maximum keratometry (Kmax) and best spectacle-corrected visual acuity (BCVA) in subgroups, which were categorized by the discrepant impregnation time period of riboflavin.

Results
We included 14 RCTs that met the eligibility criteria in this meta-analysis. At the last follow-up, CCXL was superior in postoperative change in demarcation line (SMD: −1.573; 95% CI: −2.897 to −0.248) and in Kmax (SMD:0.302; 95% CI: 0.071 to 0.533), whereas ACXL provided a significantly lower reduction in central corneal thickness (SMD: 0.498; 95% CI: 0.125 to 0.871). No differences in the changes in uncorrected visual acuity, BCVA, manifest refraction spherical equivalent, corneal biomechanical properties, and the endothelial cell density were found among both groups.

Conclusion
CCXL was superior to ACXL in greater corneal flattening and deeper demarcation line, while ACXL seemed to cause less reduction in CCT and allow for earlier UDVA stability. To clearly define the comparative safety and clinical consequences of the different regimens of CXL, more RCTs are required.

Keyword
accelerated cross-linking, corneal collagen cross-linking, different cross-linking protocols, progressive keratoconus, standard Dresden cross-linking

Q&A

14:30 - 14:40 (10 mins.)

Management of Intrastromal Corneal Cyst With Ethanol Irrigation and Cyst Wall Excision

14:40 - 14:45 (5 mins.)

Yuniar Sarah NINGTIYAS, MD - Surabaya

Abstract Detail

Abstract Title
Management of Intrastromal Corneal Cyst With Ethanol Irrigation and Cyst Wall Excision

Introduction & Objectives
To report the clinical characteristics and the surgical management of intrastromal corneal cyst.

Methods
A 13-year-old girl presented with progressive intrastromal corneal opacity and decreased vision in her left eye. The corneal opacity had increased in size for the past 12 months. The patient had no previous history of ocular trauma or ocular surgery. A presumptive diagnosis of intrastromal epithelial cyst was made upon biomicroscopy examination and corneal optical coherence tomography. Drainage of cyst content was performed followed by chemical cytodestruction using ethanol and cyst wall excision. Iridectomy and air bubble injection into the anterior chamber were also performed at the end of the surgery.

Results
Corneal clarity improved significantly following surgery. Best corrected visual acuity improved from 6/60 to 6/18 after the procedure. No recurrence was noted up to 3 months follow-up. No complications occurred during the follow-up period.

Conclusion
Intrastromal epithelial cyst may be managed effectively by combining cyst drainage, chemical cytodestruction, and cyst wall excision with good visual and cosmetic results. A longer follow-up period is warranted to monitor the recurrence.

Keyword
corneal cyst, corneal stroma, excision

Two Decades of Treatment of Keratoconus by Collagen Cross-Linking: Benefits and Barriers in A Country with High Prevalence

14:45 - 14:50 (5 mins.)

Akilesh GOKUL, MD - New Zealand

Periostin Regulates Corneal Opacity via Mesenchymal Transformation and Immune Responses

14:50 - 14:55 (5 mins.)

Seong Jae KIM, MD - South Korea

Abstract Detail

Abstract Title
Periostin Regulates Corneal Opacity via Mesenchymal Transformation and Immune Responses

Introduction & Objectives
Corneal opacity is a major cause of blindness. Corneal opacity is also known to be caused by the infiltration of immune cells induced by corneal injury. The interaction of cytokines and various extracellular matrix (ECM) proteins play an important role in corneal opacity. Periostin is a secreted matric-cellular protein associated with wound healing. Periostin is also known to be involved in infiltration of immune cells.

Methods
In this study, the effect of periostin using knockout mouse with corneal incision injury model was verified. Protein expression was confirmed by western blotting and immunofluorescence. Flow cytometric analysis and quantitative real-time PCR were used to confirm the immune cell infiltration and activation.

Results
Periostin expression was increased by corneal incision injury that induced corneal opacity. Inhibition of periostin suppressed incision-induced expression of fibronectin and α-SMA, one of the EMT-related proteins, and corneal opacity.In subsequent experiments, the infiltration of immune cells related to periostin was also found to be affected by cytokine expression in corneal opacity.

Conclusion
Periostin inhibits corneal opacity through immune response and downregulation of EMT protein during corneal wound healing. Therefore, periostin is suitable therapeutic target for corneal opacity by regulating the epithelial-mesenchymal transition and immune response in the cornea.

Keyword
Corneal opacity, Corneal wound, Periostin, Immune cell infiltration

EGF-Conditioned M1 Macrophages Convey Reduced Inflammation into Corneal Endothelial Cells Through Exosomes

14:55 - 15:00 (5 mins.)

Kyoung Woo KIM, MD - South Korea

Effect of Posterior Limbal Mesenchymal Stromal Cells for Transition Zone Cells

15:00 - 15:05 (5 mins.)

Jie ZHANG, MD - New Zealand

Q&A

15:10 - 15:20 (10 mins.)

Chairs Discussion and Best Paper of Session Announcement

15:20 - 15:30 (10 mins.)

Program Schedule

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Topics