FREE PAPER SESSION AGENDA

Opening remarks
Sunir J. Garg, MD, FACS, FASRS, Conference Chairman

Descemet’s Stripping Endothelial Keratoplasty (DSEK)
Ariel Chen, MD (F), Brandon D. Ayres, MD [Cornea & External Disease]

Purpose: To determine Descemet’s stripping endothelial keratoplasty (DSEK) detachment rates using the Busin Glide versus EndoSerter.

Methods: Retrospective cohort study. DSEK surgeries performed by a single surgeon between September 1st, 2021 to November 22nd, 2022.

Results: 53 DSEK surgeries were performed, 31 (58.5%) with Busin Glide and 22 (41.5%) with EndoSerter. Mean age of patient was 74.0 ±10.7. Prior to surgery, 16 eyes (30.2%) had DSEK, 3 (5.7%) had PK, 15 (28.3%) had tube shunt, 11 (20.8%) had trabeculectomy. DSEK surgeries had combined cataract extraction with intraocular lens (IOL) (n=4; 7.5%), secondary IOL (n=8; 15.1%), vitrectomy (n=10; 18.9%), and iridoplasty (n=7; 13.2%). Post-operative rebubbling rate was 12.9% with Busin Glide and 22.7% with EndoSerter (p=0.36).

Conclusions: DSEK surgeries with EndoSerter had a higher rate of detachment requiring rebubbling without statistical significance.

Identification of the Vibrational Optical Coherence Tomography (VOCT) Corneal Cellular Peak
Nathalie D. Daher, MD (F), Zeba A. Syed, MD, WEVOCT (Wills Eye Vibrational OCT Group) [Cornea & External Disease]

Purpose: To confirm that the 60-100Hz peak represents the human corneal cellular component using VOCT and histopathological analysis.

Methods: VOCT measurements were collected from two donated corneas before and after creating free corneal caps using a microkeratome. All lamellar sections were sent for histological analysis.

Results: The average of normalized 60-100Hz peak values before lamellar sectioning was significantly higher than the average of the peak values after the first, second, and third cuts (p=0.023). The epithelial and keratocyte cell count values in the first slice were significantly higher than the average keratocyte cell count values of the three deeper slices (p<0.00001).

Conclusions: This study suggests that the 60-100Hz cornea peak identified by VOCT corresponds to the cellular component of the cornea.

Characteristics of Patients Undergoing Genetic Testing for Keratoconus
Nicholas Hadjokas, MD (F), Brandon D. Ayres, MD [Cornea & External Disease]

Purpose: To survey the characteristics of patients undergoing Avagen genetic testing for keratoconus.

Methods: We collected the results of Avagen tests completed in a private cornea practice and looked at family history, genetic risk, and baseline Pentacam data to look for differences based on screening diagnosis.

Results: 13 patients were included. Six patients had keratoconus, five were keratoconus suspect, one was a refractive surgery evaluation, and one had post-LASIK ectasia. The majority of keratoconus and keratoconus suspects had moderate genetic risk. Positive family history was more common in keratoconus suspects. One patient had negative genetic screening but Pentacam findings consistent with keratoconus.

Conclusions: Family history often leads to screening, and further study of post-LASIK ectasia patients and the interplay of genetic risk and environmental and behavioral factors is needed.

Factors Contributing to Follow-Up Noncompliance After Infectious Keratitis Diagnosis
Pauline M. Dmitriev, MD (R), Shreya Swaminathan, BS, Christopher J. Rapuano, MD, Zeba A. Syed, MD [Cornea & External Disease]

Purpose: To evaluate clinical and socioeconomic factors that contribute to non-adherence to follow-up after diagnosis of infectious keratitis.

Methods: Retrospective chart review of patients diagnosed with infectious keratitis at the Wills Eye ER between March and September 2019.

Results: 332 patients were included with a mean age of 46.6 ± 19.1 years, and 53% were female. Sixty-nine percent of patients followed up on time, 3% were late to follow-up, and 28% did not follow-up. Patients with smaller infiltrate size (p=0.008) and those who were not cultured on initial evaluation (p=0.01) were less likely to follow-up. Among patients who were <60 years of age, lower income was associated with not following up on time (p=0.02).

Conclusion: Identifying barriers to follow-up at time of diagnosis of infectious keratitis may have important implications in preventing ulcer-related complications.

Combined Open Sky Flanged Prolene Intrascleral Intraocular Lens Fixation with Penetrating Keratoplasty
Patrick J. Burbano de Lara, MD (F), Zeba A. Syed, MD, Beeran Meghpara, MD [Cornea & External Disease]

Purpose: To report on the safety and stability of the open sky flanged prolene intrascleral intraocular lens surgical technique combined with penetrating keratoplasty.

Methods: A database search was performed to find patients in which insurance was billed for the CPT codes for “penetrating keratoplasty (phakic/aphakic/pseudophakic)” (65730/65750/65755) in addition to either “insertion of intraocular lens prosthesis” (66985) or “exchange of intraocular lens” (66986) from the time period of January 1, 2018 – November 1, 2022.

Results: 7 cases meeting surgical methodology criteria were reviewed.

Conclusion: The open sky flanged prolene intrascleral intraocular lens fixation technique appears to be a safe and effective method of visual rehabilitation in complex penetrating keratoplasty cases for patients who are either aphakic or are experiencing complications due to malpositioned intraocular lens implants.

Questions 

Cytogenetic Profile of Conjunctival Melanoma Tumors Based on Anatomical Epicenter
Kevin R. Card, BS (F), Jennifer S. Zeiger, BA, Sara E. Lally, MD, Carol L. Shields, MD [Tumor]

Purpose: Conjunctival melanoma frequently arises from mutations related to UV-light exposure. We sought to correlate UV-related and non-UV-related mutations sequenced in conjunctival melanoma with each tumor’s anatomical epicenter.

Methods: Retrospective cohort study of 122 patients with pathology-proven conjunctival melanoma whose tumors were sequenced by next-generation sequencing.

Results: 72 tumors were mapped to sun-exposed regions of the conjunctiva (medial and lateral limbal/bulbar) and 50 tumors were mapped to non-sun-exposed regions. There was no statistically significant difference in the presence of BRAF, NF1, ATRX, or at least 1 UV-related mutation between UV-exposed and UV-unexposed tumors. UV-unexposed tumors required more follow-up surgeries than UV-exposed (1.2 vs. 2.4, p = 0.003).

Conclusions: UV-related mutations occur in sun-exposed and non-sun-exposed conjunctival melanomas with no significant difference. UV-unexposed tumors require more follow-up surgeries than UV-exposed tumors.

The Cancer Genome Atlas (TCGA) Classification for Uveal Melanoma
Eleni K. Konstantinou, MD (F), Kevin R. Card, BS, Carol L. Shields, MD [Tumor]

Purpose: The Cancer Genome Atlas (TCGA) classification sought to characterize the molecular changes in cancer cells and uveal melanoma (UM).

Methods: Literature Review.

Results: The TCGA grading system includes Groups A (Disomy 3- D3, no 8q gain), B (D3, partial 8q gain), C (Monosomy 3-M3, 8q gain), and D (M3, multiple 8q gains). Shields et al showed in 1001 cases of UM that the rate of metastatic spread increased with increasing TCGA category at the 5-year mark (4% vs. 12% vs. 33% vs. 60%; p<0.001) and 10- year mark (6% vs. 20% vs. 49% vs. unavailable; p<0.001) and that melanoma-related death also increased with increasing TCGA category (<1% vs. 0% vs. 2% vs. 7%; p=0.003).

Conclusion: TCGA is a reliable classification system and highly predictive of uveal melanoma metastatic risk.

Impact of Fitzpatrick Skin Type on Metastatic Risk from Uveal Melanoma in 854 Consecutive Patients at a Single Center
Ferris M. Bayasi, MD (F), Guy S. Negretti, FRCOphth, Samuel J. Goldstein, BSPH, Carol L. Shields, MD [Tumor]

Purpose: To assess the impact of Fitzpatrick Skin Type (FST) on uveal melanoma.

Methods: Retrospective case series of 854 patients from one center with uveal melanoma and documented FST examining FST in relation to patient and tumor clinical details, tumor genetics (The Cancer Genome Atlas; TCGA), and melanoma-related metastasis and death.

Results: A comparison of patients by FST (type I vs. II vs. III-V) revealed significant differences in mean age at diagnosis (p<0.001), visual acuity <20/200 at presentation (p=0.03), mean tumor dimensions, and proportion of TCGA group B (p=0.01) or group D (p=0.01) tumors. FST I patients demonstrated significantly greater 10-year incidence of melanoma-related metastasis (p=0.02) and death (p=0.04).

Conclusions: FST was a significant predictor of melanoma-related metastasis, with metastasis more common in light compared to dark skin tone.

Relationship between Fitzpatrick Skin Type and The Cancer Genome Atlas Classification
Gregory B. Caudill, MD (F), Mrittika Sen, MD, Kevin R. Card, BS, Carol L. Shields, MD [Tumor]

Purpose: The Fitzpatrick Skin Type (FST) classifies patients based on skin color and sunburn sensitivity. The Cancer Genome Atlas (TCGA) is a genetic scale used to determine prognosis in patients with uveal melanoma. We explored the relationship between FST and TCGA.

Methods: Retrospective cohort study of 854 patients with uveal melanoma, classified by FST (scale of I-VI) and grouped using tumor genetics with TCGA (graded A, B, C, or D).

Results: Patients classified as FST I had higher odds of being TCGA group D (OR 2.34, p= 0.002). Patients classified as FST III-V had higher odds of being TCGA group B (OR 2.26, p=0.002).

Conclusions: Patients classified as FST I are more likely to have a higher-grade uveal melanoma (increased risk for metastasis), whereas those classified as FST III-V show lower grade melanoma.

Iris Melanoma Outcomes Based on The Cancer Genome Atlas (TCGA) Classification in 78 Consecutive Patients
Jennifer S. Zeiger, BA (F), Elliot Cherkas, BA, Guy S. Negretti, FRCOphth, Carol L. Shields, MD [Tumor]

Purpose: The Cancer Genome Atlas (TCGA) classification of genetic alterations in uveal melanoma is used for prognostication. As iris melanoma represents a minority of uveal melanoma, this study explores the relationship between TCGA Group and iris melanoma.

Methods: This retrospective cohort study was performed at a tertiary referral ocular oncology center. Patients were diagnosed with iris melanoma and TCGA classification was determined. Outcomes were evaluated based on TCGA Group.

Results: The sample population included TCGA Group A (n=36, 46%), B (n=7, 9%), C (n=34, 44%), and D (n=1, 1%). Group comparison yielded no significant differences in tumor recurrence, metastasis, or death.

Conclusion: In summary, greater than half the patients were TCGA Group A or B and less than half as C or D. TCGA classification was not associated with outcomes.

Correlation of Fitzpatrick Skin Type and Iris Color with Tumor Size in 854 patients with Uveal Melanoma
Matthew R. Barke, MD (F), Kushal U. Agrawal, MS, Carol L. Shields, MD [Oncology]

Purpose: To determine the correlation of Fitzpatrick Skin Type (FST) and iris color with uveal melanoma thickness and basal diameter.

Methods: Patients were classified into FST (type I, II, and III-V) and iris color (blue, green, and brown) using external photography. Tumor thickness and basal diameter were classified into small, medium, and large. The correlation was evaluated using the Kruskal-Wallis H test.

Results: A comparison of iris color showed no difference for mean tumor thickness (p=0.406) or basal diameter (p=0.477). A difference was seen for brown iris color relative to FST for mean tumor thickness (p=0.0026) and largest basal diameter (p=0.0012).

Conclusions: There was no correlation between uveal melanoma size and iris color, but brown iris color with FST type III-V was correlated with larger tumor thickness and basal diameter.

Tissue Glue for Plaque Brachytherapy of Uveal Melanoma in Humans: An Initial Experience
Konica Singla, MD (F), Kushal U. Agrawal, MS, Sara E. Lally, MD, Carol L. Shields, MD [Tumor]

Purpose: To demonstrate the utility of tissue glue to secure Iodine-125 plaque in human eyes with uveal melanoma.

Methods: Retrospective review of 9 patients with choroidal melanoma with scleral thinning treated with plaque brachytherapy. Iodine-125 plaque was secured with tissue glue followed by conjunctivoplasty to ensure complete coverage and stability of the plaque. During plaque removal, the glue clot was removed without any difficulty.

Results: In all cases, the plaque was in place for the required duration of radiation (mean, 110.2 hours; range, 101.6-162.5 hours) delivering the appropriate tumor apex dose (mean, 66.6 cGy/hr; range, 44.7-70.6 cGy/hr). During plaque removal, all plaques were in the designated position without any displacement.

Conclusions: Tissue glue is a reliable alternative to conventional suturing for securing radioactive plaque in cases of choroid melanoma with scleral thinning.

Peripheral Exudative Hemorrhagic Chorioretinopathy simulating Choroidal Melanoma
Miguel Vazquez-Memrillo, MD, PhD (F), Konica Singla, MD, Sara E. Lally, MD, Carol L. Shields, MD [Tumor]

Purpose: To discuss the clinical spectrum and outcomes of eyes with peripheral exudative hemorrhagic chorioretinopathy (PEHCR) which simulates choroidal melanoma.

Methods: Literature review.

Results: PEHCR is a degenerative process occurring in elderly Caucasian patients at the retinal periphery. It can mimic the appearance of uveal melanoma (pseudomelanoma) and other diseases such as polypoidal choroidal vasculopathy or vasoproliferative tumor. Notable clinical features of PEHCR include presence of subretinal pigment epithelium hemorrhage or fluid with variable exudation, decreased visual acuity at presentation (20/40-20/400), age (>80 years), tumor thickness (mean 3.0 mm), and temporal periphery location (equator to ora serrata). These characteristics along with findings from ultrasound, optical coherence tomography, and fundus autofluorescence are important for the diagnosis, treatment, and prognosis of PEHCR.

Conclusion: PEHCR is a hemorrhagic retinal degenerative process that simulates choroidal melanoma.

Questions

Risk Factors for Epiretinal Membrane After Rhegmatogenous Retinal Detachment Repair: Quantitative Ultra-Widefield Imaging Analysis
Asad F. Durrani, MD (F), Taku Wakabayashi, MD, PhD, Hana A. Mansour, MD, Carl D. Regillo, MD [Retina & Vitreous]

Purpose: To utilize quantitative ultra-widefield retinal imaging to investigate the risk factors associated with the incidence and severity of postoperative epiretinal membrane (ERM) in patients who underwent primary rhegmatogenous retinal detachment (RRD) repair.

Methods: Patients who underwent pars plana vitrectomy (PPV) or PPV with scleral buckle (SB) for RRD between June 2020 and February 2022 were included. Anatomic features of the retinal detachment were analyzed along with the severity of postoperative ERM formation.

Results: We included 80 eyes in this study. Postoperative ERM developed in 37 eyes (46%) at 6 months. In multivariate linear regression analysis, the only variable that remained statistically significant was the size of the drainage retinotomy (P = 0.023).

Conclusions: The pathogenesis of postoperative ERM is multifactorial. Large drainage retinotomies may increase the risk of ERM formation.

Rate and Severity of Epiretinal Membrane Formation After Scleral Buckle for Rhegmatogenous Retinal Detachment
Hana A. Mansour, MD (F), Taku Wakabayashi, MD, PhD, Meera Sivalingam, MD, Jason Hsu, MD [Retina & Vitreous]

Purpose: To report the rate and severity of epiretinal membrane (ERM) formation after scleral buckle (SB).

Methods: A retrospective review of patients who underwent SB and developed subsequent ERM.

Results: 171 of 1088 eyes (15.72%) who underwent SB developed subsequent ERM. 147 eyes met the inclusion criteria. At diagnosis, 108 (59%) eyes had grade 1 ERM, 13 (14%) grade 2, 16 (25%) grade 3 and 3 (2%) grade 4. 125 eyes (85.03%) were observed while 22 (14.97%) needed ERM peel; 10 (45.45%) of them had evidence of ERM after peel. At final visit, 109 (83.85%) eyes had grade 1 ERM, 8 (6.15%) grade 2, 10 (7.69%) grade 3 and 3 (2.31%) grade 4.

Conclusion: ERM is a common complication that develops post SB, with the majority remaining mild (grade 1).

Visual Outcomes and Incidence of Complications after Vitrectomy for Vitreous Hemorrhage Associated with Retinal Vein Occlusion
Kristine Wang, (F), Taku Wakabayashi, MD, PhD, Yoshihiro Yonekawa, MD [Retina & Vitreous]

Purpose: To report the outcomes of pars plana vitrectomy (PPV) for vitreous hemorrhage (VH) associated with retinal vein occlusion (RVO).

Methods: Single-center, retrospective, consecutive case series of patients who underwent PPV for VH associated with branch and central RVO.

Results: 138 eyes of 138 patients were included. After PPV, the mean logMAR visual acuity (VA) significantly improved from 1.95 ± 0.72 to 0.99 ± 0.87 at 6 months to 1.06 ± 0.96 at final visit. Worse final VA was associated with older age (p=0.007), concurrent neovascular glaucoma (NVG) (p<0.001), CRVO (p<0.001), worse preoperative VA (p<0.001), and new NVG (p=0.021), but not with VH duration (p=0.684).

Conclusion: PPV is an effective treatment for VH associated with RVO, regardless of VH duration. However, some pre-existing and postoperative complications may limit visual outcomes.

Laser Retinopexy in Eyes with Multifocal Intraocular Lenses: Case Control Study
Linnet Rodriguez, MD (F), Taku Wakabayashi, MD, PhD, Abtin Shahlaee, MD, Hannah E. Anderson, BS [Retina & Vitreous]

Purpose: To investigate the effects of multifocal versus monofocal IOLs on the outcomes and complications of in-office laser retinopexy for retinal tears.

Methods: Retrospective matched case-control study including patients with multifocal and monofocal IOLs who underwent laser indirect ophthalmoscopy for retinal tears.

Results: A total of 168 eyes from 163 patients were evaluated, 56 eyes with multifocal IOLs and 112 eyes with monofocal IOLs. There were no significant differences in baseline characteristics between multifocal and monofocal IOL groups. The development of RRD, vitreous hemorrhage, ERM, and symptomatic floaters were similar between the two groups (p=0.716, p=0.537, p=0.553, and p=0.422 respectively).

Conclusions: The IOL type was not significantly associated with the failure of laser. This study showed that the incidence of complications were similar in patients with either multifocal or monofocal IOLs.

Risk Factors for Surgery or Blindness in Neovascular Glaucoma Eyes Treated with Anti-VEGF Injections by a Retina Specialist
Erik Massenzio, MD (R), Robert Abishek, BA, David Xu, MD, Jason Hsu, MD [Retina & Vitreous]

Purpose: To determine baseline patient characteristics that predict need for glaucoma surgery or blindness in eyes with neovascular glaucoma (NVG) despite intravitreal anti-vascular endothelial growth factor (VEGF) therapy.

Methods: Retrospective cohort study of 301 patients with NVG treated with intravitreal anti-VEGF injections.

Results: Patients with IOP > 35mmHg (p<0.001), 2 or more topical glaucoma medications (p=0.003), worse than 20/100 vision (p=0.024), proliferative diabetic retinopathy (PDR) (p=0.001), eye pain (p=0.010), and new patient status (p=0.015) at the time of NVG diagnosis were at a higher risk of glaucoma surgery or blindness. The effect of PRP was not statistically significant in patients without media opacity (p=0.199).

Conclusions: Several baseline characteristics at the time of presentation to a retina specialist with NVG appear to portend a higher risk of uncontrolled glaucoma despite use of anti-VEGF therapy.

Questions

Break

Google Search Trends to Assess Public Interest and Concern Related to Vuity for Presbyopia
Taku Wakabayashi, MD, PhD (F), Ajay E. Kuriyan, MD, MS [Retina & Vitreous]

Purpose: To understand public awareness, interest, and concerns regarding Vuity (1.25% pilocarpine), an eye drop for presbyopia, based on Google Trends.

Methods: We used Google Trends to evaluate searches for Vuity in the United States.

Results: Since the approval of Vuity on October 29, 2021, notable increases in the relative search volumes occurred for Vuity in October 2021, December 2021, and from March to April 2022, which coincided with its approval, availability, and subsequent direct-to-consumer advertising. Specific interests included Vuity cost, where to buy it, and its side effects. Retinal detachment was the most highly searched side effect.

Conclusion: Google Trends is a useful tool for monitoring public interest in Vuity. Public concerns regarding side effects warrant further real-world investigations of the causal relationship between Vuity and retinal detachment.

Effects of Loss-to-Follow-Up on Functional and Anatomic Outcomes in Patients with Neovascular Age-Related Macular Degeneration during the COVID-19 Pandemic
Saagar A. Pandit, MD, MPH (F), Anthony Obeid, MD, MPH, Samir Patel, MD, Michael N. Cohen, MD [Retina & Vitreous]

Purpose: To study LTFU in patients receiving anti-VEGF injections for nAMD during COVID-19.

Methods: Retrospective cohort study of patients that received intravitreal bevacuzimab, ranibizumab, or aflibercept between January 2020 and March 2020 who were LTFU.

Results: Total of 7114 eyes of 5727 patients met inclusion criteria. At first return visit after LTFU, logMAR VA was 0.85 (Snellen 20/142) in LTFU group compared to 0.67 (Snellen 20/94, p<0.001) in control group. On final study visit, VA in LTFU group was decreased at 0.86 (Snellen 20/145, p<0.001). For LTFU group, mean CFT increased when comparing visit before LTFU (280 µm) to return visit (295 µm, p<0.001), but no difference at final study visit (277 µm, p=0.42).

Conclusions: Patients with nAMD treated with anti-VEGF who were LTFU during COVID-19 pandemic experienced irrecoverable loss in VA during study.

Rate and Severity of Epiretinal Membrane Formation after Pneumatic Retinopexy
Robert M. Abishek, BA (F), Hana A. Mansour, MD, Kristine Wang, Jason Hsu, MD [Retina & Vitreous]

Purpose: To report the rate and severity of epiretinal membrane (ERM) formation after pneumatic retinopexy (PR).

Methods: A retrospective chart review of all patients who underwent PR for retinal detachment (RD).

Results: 161 of 728 eyes (22%) of 728 patients who underwent PR developed subsequent ERM. 121 eyes were included in this study excluding those with prior RD or retinal tears. Mean time of ERM diagnosis after PR was 367 days. Mean logMAR VA at diagnosis was 0.536 and improved to 0.395 at final visit (p<0.001). 79 (71%) eyes developed grade 1 ERM, 15 (13%) grade 2, 11 (10%) grade 3, and 7 (6%) grade 4. 102 eyes (85%) were observed while 19 (15%) required ERM peel.

Conclusion: ERM is a common complication that develops around 1 year post PR.

Geographic Access to Pediatric Retina Specialists in the United States
Lucy V. Cobbs, MD (R), Rebecca Soares, MD, Yoshihiro Yonekawa, MD [Retina & Vitreous]

Purpose: We aim to map out the geographic distribution of pediatric retina practices to identify populations with barriers to accessing their care.

Methods: Our study used the American Society of Retina Specialists website (asrs.org) to identify pediatric retina specialists practicing within the United States. We used Census Bureau data to identify communities with greater travel burdens to pediatric retina practices.

Results: Census tracts with greater percentages of very-low birthweight neonates had shorter travel times. Rural populations with lower socioeconomic status and education levels had longer travel times.

Conclusions: Importantly, populations at greatest risk for developing retinopathy of prematurity had shorter travel times to pediatric retina specialists. However, vulnerable communities, including those living below the poverty line, with lower education levels, and rural dwelling, had impaired access to care.

A Comparison of Ocular Complications after 0.7-mg Dexamethasone Implant Versus 2 mg of Intravitreal Triamcinolone in Vitrectomized Eyes
Anand D. Gopal, MD (F), Taku Wakabayashi, MD, PhD, Raziyeh Mahmoudzadeh MD, Marc J. Spirn, MD [Retina & Vitreous]

Purpose: To compare complication rates in eyes receiving dexamethasone (DEX) implant (0.7 mg) or intravitreal triamcinolone (IVT) (2 mg) for post-vitrectomy macular edema (ME).

Methods: A retrospective, comparative case series of 148 eyes from 147 patients was performed. Records of patients who received intravitreal DEX implant 0.7 mg (Ozurdex®) or triamcinolone (2 mg) (Triesence®) for post-vitrectomy ME between July 2014 and December 2021 with minimum follow-up of three months were reviewed to identify types and rates of complications.

Results: There were 75 and 72 eyes in the DEX and IVT groups, respectively. Rates of transient hypotony per eye and injection were significantly higher in the DEX group compared with the IVT group (P = 0.039 and <0.001, respectively). There were no significant between-group differences in incidence of ocular hypertension, vitreous hemorrhage, or retinal detachment.

Conclusion: Incidence of hypotony was higher in vitrectomized eyes treated with DEX compared with eyes treated with IVT. Rates of other complications were similarly low between groups.

Questions

Outcomes of Glaucoma Filtering Surgery in Patients 85 and Older: A Retrospective Study
Christian Nieves, MD (F), Shahin Hallaj, MD, Dilru C. Amarasekera, MD, Reza Razeghinejad, MD [Glaucoma]

Purpose: To compare surgical outcomes of Xen, trabeculectomy, and tube in patients with glaucoma aged >85 years.

Methods: 82 patients included in this retrospective study. Failure was defined as IOP reduction <20%, additional surgery, progression to no light perception, or post-operative number of medications (NOM) > pre-operative.

Results: Trabeculectomy(p=0.016) and tube (p=0.001) had significantly higher success than Xen. At one year, trabeculectomy had higher IOP reduction (51.2%) than tube (42.7%) or Xen(28.5%)(p=0.03) and lower NOM at 2 years(p=0.041). Choroidal effusion and hemorrhage were noted in 7.7% of tube shunt,10.0% of trabeculectomy, and none of Xen patients.

Conclusions: Tube shunt and trabeculectomy were more effective than Xen in lowering the IOP. However, Xen was associated with the lowest rate of complications

Comparing Outcomes of Bent Needle Versus Kahook Dual Blade Goniotomy
Dilru C. Amarasekera, MD (F), Sagar J. Shah, BS, Aakriti Shukla, MD, Daniel Lee, MD [Glaucoma]

Purpose: Minimally invasive glaucoma surgery is a mainstay of glaucoma management. The Kahook Dual Blade (KDB) is a goniotomy device that has shown significant, lasting, IOP reduction. A bent 25-gauge needle can be used to perform a goniotomy using a similar technique, but at a significantly lower cost. In this study we compare clinical outcomes of bent needle versus KDB goniotomy.

Methods: A retrospective chart review of 102 patients who received bent needle or KDB goniotomy was performed. Patients with prior incisional glaucoma surgery were excluded. Outcomes measured included IOP, number of medications, and complication rates.

Results: No significant differences in outcomes were found between bent needle and KDB goniotomies. Success rates at 1 year were similar.

Conclusions: Bent needle goniotomy may represent a cost-effective alternative to KDB goniotomy.

Selective Laser Trabeculoplasty (SLT) in Pseudophakic Patients with vs. without Prior Trabecular Meshwork Bypass Microstent Implantation: A Retrospective Cohort Comparison
Michael Izzo, MD (F), Jonathan S. Myers, MD, Sagar J. Shah, BS, Nicholas O’Connor, DO [Glaucoma]

Purpose: The purpose of this study is to examine the safety and efficacy of SLT after implantation of a trabecular meshwork bypass microstent (“TMMS”) combined with cataract surgery.

Methods: This was a retrospective analysis of eyes that underwent SLT following TMMS implantation compared to a matched cohort of pseudophakic eyes that had SLT. Success was defined as greater than 20% IOP reduction, analyzed by Kaplan-Meier survival.

Results: Less eyes, 45% versus 78%, met success criteria in the case versus control group at 1 year post-SLT (p=0.025). Medications were reduced from a mean of 2.2 +/- 0.9 to 1.7 +/- 1 in the study group.

Conclusion: This data suggests that SLT is less effective at reducing IOP after phacoemulsification plus TMMS however may help to reduce medication burden.

Trabeculectomy versus Tube Shunt in Eyes Presenting with Intraocular Pressure of More than 40mmHg: A Retrospective Study
Sagar J. Shah, BS (F), Shahin Hallaj, MD, Christian Nieves, MD, Natasha N. Kolomeyer, MD [Glaucoma]

Purpose: This study compares the clinical outcomes of trab versus tube in primary open angle glaucoma with intraocular pressure (IOP) >40mmHg.

Methods: Retrospective analysis of 70 eyes were included. Failure was defined as IOP reduction of <20%; IOP>21 or<5mmHg; post-operative number of medications (NOM) > pre-operative after 3 months; further glaucoma surgery; progression to no light perception.

Results: Baseline characteristics were similar between groups. Trab required less medications at 1, 3, and 6-months (p<0.001) and had greater one-year success than tubes (82% vs. 68.3%; p=0.200). Complications including choroidal effusion/hemorrhage and endophthalmitis occurred in <3% trabs and 13.9% tubes (p=0.01)

Conclusion: Trab may have advantages in some eyes with IOP>40 including less glaucoma meds and sight-threatening complications, and higher 1-year success rate.

Family Glaucoma Risk Communication: A Community-Based Online Intervention
Shahin Hallaj, MD (F), Sagar J. Shah, B.S., Rosemary Frasso, PhD, MSc, MSc, CPH, Natasha N. Kolomeyer, MD [Glaucoma]

Purpose: Given the up to tenfold increased risk of glaucoma in first-degree relatives (FDRs) of patients, this study aims to understand preferences related to intrafamilial risk communication,

Methods: Semi-structured, intercept interviews with open-ended questions were conducted to explore preferences related to glaucoma risk communication. Interviews were analyzed using NVivo software. The results were used to design an educational intervention.

Results: Most participants were unfamiliar with glaucoma and the increased risk of patients’ FDRs They preferred to receive information about the educational platform electronically and , from a trustworthy website.

Conclusion: A web-based educational protocol may motivate FDRs of glaucoma patients to seek eye care and is being studied prospectively.

Surgical Efficacy of Continuous Wave Trans-Scleral and Micropulse Cyclophotocoagulation in Treatment of Glaucoma
Tina Xia, MD (F), Shahin Hallaj, MD, Sopuruchkwu Ezeonu, BS, Reza Rhazeghinejad, MD [Glaucoma]

Purpose: To assesses surgical outcomes of MP3 and G-Probe CPC.

Methods: Retrospective study of G-Probe (n=121) and MP3 (n=352) surgical outcomes. Failure rate was also assessed.

Results: At 1 year, mean IOP was 13.6±6.5mmHg (-48.7%) in G-Probe group (n=34) and 15.5±8.5mmHg (-39.9%) in MP3 group (n=93). Pre-operative medications were higher with G-Probe than MP3 (4.1±1.5 vs 3.6±1.4, p=0.004) but decreased post-operatively for both groups. At 1 year, failure rate was 44.6% for G-probe and 54% for MP3.

Conclusions: G-Probe and MP3 CPC were effective in reducing IOP and medications. Some baseline characteristics differed. The average IOP at year 1 appear to be lower in the G-Probe cohort. At 1 year, approximately half of patients in each CPC group reached failure criteria.

Questions

Consultation in Eye Pathology: Experience at The Ophthalmology Specialty Hospital
Orlando G. González Martínez, MD (F), Martin Calotti, BMSc, MMASc, Roger Henry, MD, Tatyana Milman, MD [Ocular Pathology]

Purpose: Diagnosing ocular lesions can be challenging, often necessitating referral for a second opinion. We analyze referral patterns, diagnostic challenges and discrepancies in referrals to an ocular pathology center.

Methods: Retrospective study of 1172 consultations to a single ocular pathology center between December 2015 and December 2022.

Results: Of 1172 consultations, 904 (77%) were from general pathologists and 636 (54%) were referred due to self-perceived inexperience in ocular pathology. 516 (44%) cases were referred without a diagnosis – most frequently corneal (115, 88%); intraocular (59, 44%); and conjunctival (160, 39%) biopsies. Of 656 cases referred with a diagnosis, 109 (17%) were discrepant and 43 (7%) had a change in categorical interpretation.

Conclusion: Diagnostic discrepancies of ocular lesions can influence clinical management. Adequate sampling, clinical correlation, and referral to an ocular pathology center may be warranted.

Outcomes of Plication Surgery for Horizontal Strabismus
Cigdem Ozturk, MD (F), Karen E. Lee, MD, Kammi B. Gunton, MD, Maureen Lloyd, MD [Pediatric Ophthalmology]

Purpose: To report the postsurgical alignment, wound healing, and patient satisfaction with horizontal muscle plication.

Methods: 8 patients who underwent plication of a horizontal extraocular muscle were recruited. Participants ranked pain and redness on a Likert scale from 1-5 at each postoperative visit. Eyelid swelling, chemosis, and injection were graded on a 0-2 scale.

Results: Patient assessment of redness and pain improved within 3-5 weeks postoperatively by an average of 0.25 and 0.75 on the Likert scale, respectively. Swelling, chemosis, and injection was improved in the same period by 0.71, 0.71, and 0.57 on the 0-2 scale, respectively. The average change in alignment postoperatively was 35.75 PD, with an average residual misalignment of 5.25 PD.

Conclusions: Plication achieves excellent postoperative alignment, improvements in patient assessment of confidence, satisfaction with appearance

The Role of Physical Activity in Adolescents with Amblyopia
Karen E. Lee, MD (F), Ava Torjani, Tobin Thuma DO, Kammi B. Gunton MD [Pediatric Ophthalmology]

Purpose: To examine any association between amblyopia and overall physical activity (PA) in adolescents ages 12 to 18.

Methods: A 32-question survey was used to determine level and type of PA over the past 7 days. Medical records were reviewed for patient demographics, ocular history, BCVA, and BMI.

Results: Amblyopia subjects trended to less overall physical activity compared to control subjects (p = 0.885). The most common activities were biking and running in amblyopia subjects. Amblyopic subjects were as likely to participate in contact sports, 45.7% compared to 33.3%, respectively (p = 0.472).

Conclusions: Amblyopia patients were minimally less active in adolescence, but just as likely to participate in contact sports. There is no statistically significant impact of presence of amblyopia on overall physical activity in this age group.

Management of the Traumatic Cataract during Ruptured Globe Repair at Wills Eye Hospital: A Comprehensive Retrospective Review
Talia N. Shoshany, MD (R), Zeba A. Syed, MD, Ava Torjani [Trauma]

Purpose: To compare outcomes of primary (PL) vs. delayed lensectomy (DL) in ruptured globes (RG) with lens violation.

Methods: Retrospective review of anterior RGs with lens violation undergoing repair (RGR) at Wills between 2017-2022. Best-corrected VA (BCVA), IOP, endophthalmitis and retinal detachment (RD) incidence, and need for additional procedures were compared between PL and DL groups.

Results: 30 patients were included to-date. Seven had primary lensectomy. Seven required lensectomy within the first month due to inflammation or IOP spike. Average final BCVA and peak IOP were 20/30 and 20mmHg for PL group, and 20/100 and 30mmHg for DL group, respectively. Both groups had no incidence of endophthalmitis, while the DL group had 2 cases of RD.

Conclusions: Primary lensectomy during RGR may be associated with better BCVA, lower IOP, and reduced need for additional procedures.

Utilization of the Wills Eye Emergency Room Following Social Distancing
Cathy Y. Zhang, MD (R), Sophie Lam, MD, Tara A. Uhler, MD [Wills Eye Emergency Room]

Purpose: To study utilization of the Wills Eye Emergency Room (WER) the year following initiation of COVID-related social distancing (03/2020 – 03/2021).

Methods: Data was gathered using Epic SlicerDicer.

Results: The total number of WER visits between 03/2019 – 03/2020 decreased by 18% compared to the number of visits the year prior. The top ten “emergent” ophthalmic diagnoses as defined by the American Academy of Ophthalmology (AAO) made up 15.3% of the total patient diagnoses seen during 03/2019 – 03/2020. This percentage was unchanged during 03/2020 – 03/2021, and decreased to 14.9% during 03/2021– 03/2022.

Conclusions: While the total number of WER visits decreased after initiation of social distancing, the diagnoses seen at the WER did not skew toward “emergent” diagnoses as defined by the AAO.

Outcomes of Light Adjustable IOL Using Open-Access Co-Managed Model
Sarah Amanullah, MD (R), Mark F. Pyfer, MD [Cataract & IOL]

Purpose: To report outcomes of a new light adjustable lens (LAL) using an open access center for post-operative lens power adjustments.

Method: The RxSight LAL is a silicone IOL containing UV-photosensitive macromers that permanently alter its refractive power using UV light from a computer-controlled light delivery device (LDD). A retrospective case series was analyzed from one surgeon’s initial LAL experience, with adjustments performed by a trained co-managing optometrist. Visual acuity (VA), complications, patient symptoms, and final refraction at 1-3 months post lock-in were recorded.

Results: 20 eyes of 24 patients were identified. 14 eyes had prior corneal refractive surgery. There were no intraoperative or postoperative complications. All patient had final binocular uncorrected VA of 20/25 and J3 or better.

Conclusion: The co-managed adjustment model was convenient for patients and improved time efficiency without increasing risk.

Questions

Closing Remarks

Adjourn